US20150032024A1 - Methods and apparatus for removing material from within a mammalian cavity using an insertable endoscopic instrument - Google Patents

Abstract

An endoscope for removing tissue at a surgical site includes an elongated tubular body insertable within a mammalian cavity of a patient. An instrument channel extends between a first opening at a distal end and a second opening at a proximal end of the tubular body and is sized and configured to receive a surgical cutting assembly that includes an aspiration channel configured to remove material entering the endoscope via a distal end of the surgical cutting assembly. A torque generation component configured to generate torque is positioned within the distal end and configured to provide the generated torque to a coupling component. The coupling component is positioned at the distal end of the elongated tubular member and configured to actuate a cutting component of the surgical cutting assembly responsive to actuation of the torque generation component.

Description

RELATED APPLICATIONS
• This application is a continuation in part and claims priority to U.S. application Ser. No. 14/280,202, filed on May 16, 2014, which claims the benefit of and priority to U.S. Provisional Patent Application 61/824,760, filed on May 17, 2013. U.S. application Ser. No. 14/280,202 is a continuation in part and claims priority to U.S. patent application Ser. No. 13/336,491, filed on Dec. 23, 2011, which claims the benefit of and priority to U.S. Provisional Patent Application 61/566,472, filed on Dec. 2, 2011. Each of these applications are incorporated herein by reference in their entirety for all purposes.
BACKGROUND
• Colon cancer is the third leading cause of cancer in the United States but is the second leading cause of cancer-related deaths. Colon cancer arises from pre-existing colon polyps (adenomas) that occur in as many as 35% of the US population. Colon polyps can either be benign, precancerous or cancerous. Colonoscopy is widely regarded as an excellent screening tool for colon cancer that is increasing in incidence worldwide. According to the literature, a 1% increase in colonoscopy screening results in a 3% decrease in the incidence of colon cancer. The current demand for colonoscopy exceeds the ability of the medical system to provide adequate screening. Despite the increase in colon cancer screening the past few decades, only 55% of the eligible population is screened, falling far short of the recommended 80%, leaving millions of patients at risk.
• Due to the lack of adequate resources, operators performing a colonoscopy typically only sample the largest polyps, exposing the patient to sample bias by typically leaving behind smaller less detectable polyps that could advance to colon cancer prior to future colonoscopy. Because of the sample bias, a negative result from the sampled polyps does not ensure the patient is truly cancer-free. Existing polyps removal techniques lack precision and are cumbersome and time consuming.
• At present, colon polyps are removed using a snare that is introduced into the patient's body via a working channel defined within an endoscope. The tip of the snare is passed around the stalk of the polyp to cut the polyp from the colon wall. Once the cut has been made, the cut polyp lies on the intestinal wall of the patient until it is retrieved by the operator as a sample. To retrieve the sample, the snare is first removed from the endoscope and a biopsy forceps or suction is fed through the same channel of the endoscope to retrieve the sample.
• Accordingly, there is a need for an improved endoscopic instrument that increases the precision and speed of polyp removal for biopsy.
SUMMARY
• An improved endoscopic instrument is provided that can precisely remove sessile polyps and efficiently obtain samples of multiple polyps from a patient. In particular, the improved endoscopic instrument is capable of debriding one or more polyps and retrieving the debrided polyps without having to alternate between using a separate cutting tool and a separate sample retrieving tool. The sampling can be integrated with colonoscopy inspection. In some implementations, the endoscopic instrument can cut and remove tissue from within a patient. In some such implementations, the endoscopic instrument can cut and remove tissue substantially simultaneously from within a patient accessed through a flexible endoscope.
• In one aspect, an endoscopic instrument insertable within a single instrument channel of an endoscope includes a power-driven instrument head configured to resect material at a site within a subject having been reached by a flexible endoscope with working channel. The power-driven instrument head has a first distal end and a first proximal end. The first distal end of the power-driven instrument head defines a material entry port through which the resected material can enter the flexible endoscopic instrument. A body is coupled to the first proximal end of the power-driven instrument head and configured to drive the power-driven instrument head. The body includes a flexible portion that has a second distal end and a second proximal end. The second proximal end of the flexible portion defines a material exit port. An aspiration channel extends from the material entry port of the power-driven instrument head to the material exit port of the flexible portion. The second proximal end of the flexible portion is configured to couple to a vacuum source such that the resected material entering the aspiration channel via the material entry port is removed from the aspiration channel at the material exit port while the endoscopic instrument is disposed within an instrument channel of a flexible endoscope.
• In some implementations, the body further includes a powered actuator. The powered actuator is coupled to the first proximal end of the power-driven instrument head and configured to drive the power-driven instrument head. In some implementations, the powered actuator is one of a hydraulically powered actuator, a pneumatically powered actuator or an electrically powered actuator. In some implementations, the powered actuator includes at least one of an electric motor, a tesla rotor, and a vane rotor. In some implementations, the endoscopic instrument includes an energy storage component configured to power the powered actuator. In some implementations, the aspiration channel is defined by the power-driven instrument head, the powered actuator and the flexible portion.
• In some implementations, the powered actuator is one of a hydraulically powered actuator or a pneumatically powered actuator. In some such implementations, the flexible portion includes a fluid inlet tubular member configured to supply irrigation to actuate the power actuator and a fluid outlet tubular member configured to remove the fluid being supplied to actuate the actuator. In some implementations, the flexible portion includes an aspiration tubular member that defines a proximal portion of the aspiration channel.
• In some implementations, the powered actuator includes a hollow portion, the hollow portion fluidly coupling the material entry port of the power-driven instrument head and the material exit port of the flexible portion.
• In some implementations, the instrument includes an engagement assembly configured to contact the walls of the instrument channel of the endoscope when actuated. In some implementations, the engagement assembly includes a compliant ring structure configured to be deformed.
• In some implementations, the power-driven instrument head includes an outer structure and a cutting shaft disposed within the outer structure, the cutting shaft coupled to the powered actuator and configured to rotate relative to the outer structure when the powered actuator is actuated. In some implementations, the cutting shaft includes a hollow portion and the material entry port.
• In some implementations, the flexible portion includes a hollow flexible torque cable. The flexible torque cable has a distal region configured to couple to the first proximal end of the power-driven instrument head and has a proximal region configured to couple to a powered actuator. In some implementations, the flexible torque cable defines a portion of the aspiration channel. The distal region of the flexible torque cable is fluidly coupled to the material entry port of the power-driven instrument head and the proximal region of the flexible torque cable includes the material exit port.
• In some implementations, the instrument has an outer diameter that is less than about 5 mm. In some implementations, the flexible portion is at least 40 times as long as the power-driven instrument head. In some implementations, the outer diameter of the powered actuator is less than about 4 mm.
• According to another aspect, an endoscopic instrument includes a power-driven instrument head configured to resect material at a site within a subject. The power-driven instrument head includes a cutting tip and a material entry port configured to allow material to enter a distal end of the endoscopic instrument. A body is coupled to the power-driven instrument head. The body includes an elongated hollow flexible tubular member that includes a material exit port configured to allow material to exit a proximal end of the endoscopic instrument. An aspiration channel extends from the material entry port of the power-driven instrument head to a material exit port of the elongated hollow flexible tubular member. The second proximal end of the flexible portion is configured to fluidly couple to a vacuum source such that the resected material that enters the aspiration channel via the material entry port of the power-driven instrument head is removed from the endoscopic instrument via the material exit port. The endoscopic instrument is configured to travel through a tortuous instrument channel of an endoscope. In some implementations, the instrument has an outer diameter that is less than about 5 mm and wherein the flexible tubular member is at least 72 inches long.
• In some implementations, the body further comprises a powered actuator, the powered actuator coupled to the first proximal end of the power-driven instrument head and configured to drive the power-driven instrument head. In some implementations, the powered actuator is an electrically powered actuator and further comprising an electrically conducting wire configured to couple to a power source. In some implementations, the aspiration channel is defined by the power-driven instrument head, the powered actuator and the flexible portion. In some implementations, the flexible tubular member defines a proximal portion of the aspiration channel.
• In some implementations, the powered actuator is one of a hydraulically powered actuator or a pneumatically powered actuator, and further includes a fluid inlet tubular member configured to supply fluid to actuate the power actuator and a fluid outlet tubular member configured to remove the fluid being supplied to actuate the actuator.
• In some implementations, the instrument includes an engagement assembly configured to contact the walls of the instrument channel of the endoscope when actuated. In some implementations, the engagement assembly includes a vacuum actuated structure configured to move into an engaged position in which the vacuum actuated structure is not in contact with the instrument channel when the vacuum is actuated and configured to move into a retracted position in which the vacuum actuated structure is not in contact with the instrument channel when the vacuum is not actuated.
• In some implementations, the power-driven instrument head includes an outer structure and a cutting shaft disposed within the outer structure, the cutting shaft coupled to the powered actuator and configured to rotate relative to the outer structure when the powered actuator is actuated.
• In some implementations, the flexible tubular member includes a hollow flexible torque cable. The flexible torque cable has a distal region configured to couple to the first proximal end of the power-driven instrument head and has a proximal region configured to couple to a powered actuator located external to the endoscopic instrument. In some implementations, the flexible torque cable further defines a portion of the aspiration channel, wherein the distal region of the flexible torque cable is fluidly coupled to the material entry port of the power-driven instrument head and the proximal region of the flexible torque cable includes the material exit port. In some implementations, the instrument includes a sheath surrounding the flexible torque cable.
• According to another aspect, a flexible endoscopic biopsy retrieval tool adapted for use with an endoscope includes a housing, a debriding component coupled to the housing, and a sample retrieval conduit disposed within the housing for retrieving debrided material that is debrided by the debriding component. In various embodiments, an improved flexible endoscope may be configured with an integrated endoscopic biopsy retrieval tool that includes a debriding component and a sample retrieval conduit for retrieving debrided material that is debrided by the debriding component.
• According to another aspect, a method of retrieving polyps from a patient's body includes disposing an endoscopic instrument within an instrument channel of an endoscope, inserting the endoscope in a patient's body, actuating a debriding component of the endoscopic instrument to cut a polyp within the patient's body, and actuating a sample retrieval component of the endoscopic instrument to remove the cut polyp from within the patient's body.
• According to yet another aspect, an endoscope includes a first end and a second end separated by a flexible housing. An instrument channel extends from the first end to the second end and an endoscopic instrument is coupled to the instrument channel at the first end of the endoscope. The endoscopic instrument includes a debriding component and a sample retrieval conduit partially disposed within the instrument channel.
• According to yet another aspect, an endoscopic instrument is insertable within a single instrument channel of an endoscope includes a cutting assembly that is configured to resect material at a site within a subject. The cutting assembly includes an outer cannula and an inner cannula disposed within the outer cannula. The outer cannula defines an opening through which material to be resected enters the cutting assembly. The endoscopic instrument also includes a flexible outer tubing coupled to the outer cannula. The flexible outer tubing is configured to cause the outer cannula to rotate relative to the inner cannula. The flexible outer tubing can have an outer diameter that is smaller than the instrument channel in which the endoscopic instrument is insertable. The endoscopic instrument also includes a flexible torque coil having a portion disposed within the flexible outer tubing. The flexible torque coil having a distal end coupled to the inner cannula. The flexible torque coil is configured to cause the inner cannula to rotate relative to the outer cannula. The endoscopic instrument also includes a proximal connector coupled to a proximal end of the flexible torque coil and configured to engage with a drive assembly that is configured to cause the proximal connector, the flexible torque coil and the inner cannula to rotate upon actuation. The endoscopic instrument also includes an aspiration channel having an aspiration port configured to engage with a vacuum source. The aspiration channel is partially defined by an inner wall of the flexible torque coil and an inner wall of the inner cannula and extends from an opening defined in the inner cannula to the aspiration port. The endoscopic instrument also includes an irrigation channel having a first portion defined between an outer wall of the flexible torque coil and an inner wall of the flexible outer tubing and configured to carry irrigation fluid to the aspiration channel.
• In some implementations, the proximal connector is hollow and an inner wall of the proximal connector defines a portion of the aspiration channel. In some implementations, the proximal connector is a rigid cylindrical structure and is configured to be positioned within a drive receptacle of the drive assembly. The proximal connector can include a coupler configured to engage with the drive assembly and a tensioning spring configured to bias the inner cannula towards a distal end of the outer cannula. In some implementations, the tensioning spring is sized and biased such that the tensioning spring causes a cutting portion of the inner cannula to be positioned adjacent to the opening of the outer cannula. In some implementations, the proximal connector is rotationally and fluidly coupled to the flexible torque coil.
• In some implementations, the endoscopic instrument also includes a lavage connector including an irrigation entry port and a tubular member coupled to the lavage connector and the flexible outer tubing. An inner wall of the tubular member and the outer wall of the flexible torque coil can define a second portion of the irrigation channel that is fluidly coupled to the first portion of the irrigation channel. In some implementations, the endoscopic instrument also includes a rotational coupler coupling the flexible outer tubing to the tubular member and configured to cause the flexible outer tubing to rotate relative to the tubular member and cause the opening defined in the outer cannula to rotate relative to the inner cannula. In some implementations, the lavage connector defines an inner bore within which the flexible torque coil is disposed.
• In some implementations, the endoscopic instrument also includes a lining within which the flexible torque coil is disposed, the outer wall of the lining configured to define a portion of the irrigation channel. In some implementations, the inner cannula is configured to rotate axially relative to the outer cannula and the aspiration channel is configured to provide a suction force at the opening of the inner cannula.
• In some implementations, the flexible torque coil includes a plurality of threads. Each of the plurality of threads can be wound in a direction opposite to a direction in which one or more adjacent threads of the plurality of threads is wound. In some implementations, the flexible torque coil includes a plurality of layers. Each of the plurality of layers can be wound in a direction opposite to a direction in which one or more adjacent layers of the plurality of layers is wound. In some implementations, each layer can include one or more threads.
• In some implementations, the flexible outer tubing has a length that exceeds the length of the endoscope in which the endoscopic instrument is insertable. In some implementations, the flexible outer tubing has a length that is at least 100 times larger than an outer diameter of the flexible outer tubing. In some implementations, the flexible portion is at least 40 times as long as the cutting assembly.
• According to another aspect, an endoscopic assembly includes a flexible endoscopic instrument including a cutting assembly configured to resect material at a site within a subject, the cutting assembly including an outer cannula and an inner cannula disposed within the outer cannula, the outer cannula defining an opening through which material to be resected enters the cutting assembly. A flexible outer tubing is coupled to the outer cannula and is configured to cause the outer cannula to rotate relative to the inner cannula, the flexible outer tubing having an outer diameter that is smaller than the instrument channel in which the flexible endoscopic instrument is insertable. An aspiration tube has a portion disposed within the flexible outer tubing. The aspiration tube has a distal end coupled to the inner cannula, the aspiration tube defining a portion of an aspiration channel through which the material resected by the cutting assembly is removed. The aspiration channel is partially defined by an inner wall of the aspiration channel and an inner wall of the inner cannula and extending from an opening defined in the inner cannula to a proximal end of the aspiration tube. An irrigation channel having a first portion defined between an outer wall of the aspiration tube and an inner wall of the flexible outer tubing and configured to carry irrigation fluid to the aspiration channel. The endoscopic assembly also includes an endoscope within which the flexible endoscopic instrument is insertable. The endoscope includes an elongated tubular body having a distal end and a proximal end, the distal end sized to be inserted within a mammalian cavity of a patient and including a camera configured to capture images of the mammalian cavity. The distal end extends a predetermined length from a distal tip that is at least less than half of a length of the elongated tubular body. An instrument channel extending between a first opening at the distal end and a second opening at the proximal end. The instrument channel sized and configured to receive a removable surgical cutting assembly that includes an aspiration channel configured to fluidly couple, at a proximal end of the surgical cutting assembly, to a suction source to remove material entering the endoscope via a distal end of the surgical cutting assembly. A torque generation component configured to generate torque and positioned within the distal end, the torque generation component configured to provide the generated torque to a coupling component responsive to actuation of the torque generation component. The coupling component is positioned at the distal end of the elongated tubular member, the coupling component configured to actuate a cutting component of the surgical cutting assembly responsive to actuation of the torque generation component.
• According to another aspect, an endoscope for removing tissue at a surgical site, includes an elongated tubular body having a distal end and a proximal end. The distal end is insertable within a mammalian cavity of a patient. The proximal end configured to remain outside the mammalian cavity of the patient. An instrument channel extends between a first opening at the distal end and a second opening at the proximal end, the instrument channel sized and configured to receive a removable surgical cutting assembly that includes an aspiration channel configured to fluidly couple, at a proximal end of the surgical cutting assembly, to a suction source to remove material entering the endoscope via a distal end of the surgical cutting assembly. A torque generation component configured to generate torque and positioned within the distal end, the torque generation component configured to provide the generated torque to a coupling component responsive to actuation of the torque generation component. The coupling component is positioned at the distal end of the elongated tubular member. The coupling component configured to actuate a cutting component of the surgical cutting assembly responsive to actuation of the torque generation component.
• In some implementations, a length of the coupling component is sized to allow the endoscope to be inserted within a mammalian cavity of the patient.
• In some implementations, the coupling component includes a magnetic coupler, the magnetic coupler having a magnetic force sufficient to magnetically couple with a magnetic coupling component of the surgical cutting assembly to cause the magnetic coupler of the surgical cutting assembly to rotate relative the first portion of the surgical cutting assembly. In some implementations, the inner diameter of the magnetic coupler is sized to exceed a diameter of the instrument channel. In some implementations, the outer wall of the magnetic coupler includes frictional elements configured to rotatably engage with the torque generation component. In some implementations, the torque generation component includes an electrical rotary actuator, the endoscope further comprising an electrical wire configured to deliver current to the electrical rotary actuator. In some implementations, the magnetic coupler forms a rotatable portion of the torque generation component. In some implementations, the torque generation component is one of a hydraulic driven rotary actuator or a pneumatic driven rotary actuator; and the endoscope further includes a fluid delivery channel configured to deliver fluid to the torque generation component and a fluid removal channel configured to remove the fluid from the torque generation component.
• In some implementations, the torque generation component is configured to rotate an inner cannula of the surgical cutting assembly relative to an outer cannula of the surgical cutting assembly.
• In some implementations, the torque generation component is configured to couple to a linear motion assembly that converts the torque generated by the torque generation component to linear motion. In some implementations, the torque generation component is configured to rotate in a first direction to cause the coupling component to move from a first position to a second position in a direction from the proximal end to the distal end and to rotate in a second direction to cause the coupling component to move from the second position to the first position, wherein the torque generation component is configured to alternate between rotating in the first direction and the second direction to cause an inner cannula of the surgical cutting assembly to reciprocate between a first open position in which a distal tip of the inner cannula is a first predetermined distance away from a distal tip of an outer cannula of the surgical cutting assembly and a second closed position in which the distal tip of the inner cannula is less than a second predetermined distance away from the distal tip of the outer cannula, wherein the second predetermined distance is less than the first predetermined distance.
• In some implementations, the instrument channel is defined to receive the surgical cutting assembly via the second opening at the proximal end of the instrument channel. In some implementations, the instrument channel is configured to include at least one groove configured to engage with a corresponding key of the surgical cutting assembly to ensure that an orientation of an opening of an outer cannula of the surgical cutting assembly is aligned with respect to a camera of the endoscope.
• In some implementations, the coupling component is a magnetic coupler that magnetically couples to a coupling member attached to an inner cannula of the surgical cutting assembly such that the coupling component transfers the torque generated by the torque generation component to the inner cannula of the surgical cutting assembly via the coupling member attached to the inner cannula.
• In some implementations, the endoscope includes an articulation assembly configured to engage an outer cannula of the surgical cutting assembly, the articulation assembly configured to cause the outer cannula to rotate relative to the inner cannula. In some implementations, the articulation assembly is configured to rotate the outer cannula between a plurality of predetermined positions.
• In some implementations, the endoscope includes a deployment component configured to be actuated by an actuator, the deployment component configured to maintain the surgical cutting assembly disposed within the tubular body in a first undeployed position and configured to deploy the surgical cutting assembly from the first undeployed position to a second deployed position upon actuation of the deployment component. In some implementations, the deployment component is configured to move between a closed state in which the surgical cutting assembly is maintained in the first undeployed position and an opened state in which the surgical cutting assembly is deployed to the second deployed position. In some implementations, when the surgical cutting assembly is in the second deployed position, an outer cannula of the surgical cutting assembly extending outwardly along a longitudinal axis of the endoscope from the distal end of the endoscope and having a cutting window that is positioned at a distance away from a camera of the endoscope that allows the cutting window to be viewed in an image captured by the camera.
• In some implementations, the endoscope includes an actuation console that includes at least one actuator to actuate the torque generation component. In some implementations, the coupling component has an inner wall through which a longitudinal axis of the instrument channel extends and within which a portion of the instrument channel is disposed.
• In some implementations, the torque generation component and the coupling component are disposed within a region of the distal end of the endoscope that extends between the distal tip of the elongated tubular body and a portion of the elongated tubular body within which the steerable assembly is disposed.
• In some implementations, the endoscope can include an irrigation channel extending from the proximal end to an opening defined within a wall of the tubular body that defines the instrument channel. The irrigation channel is configured to fluidly connect to an irrigation pathway defined within the surgical cutter assembly. The surgical cutting assembly can be configured to allow irrigation fluid entering the proximal end of the endoscope to flow into the irrigation pathway defined between an outer cannula and an inner cannula of the surgical cutter assembly when the surgical cutter assembly is inserted within the instrument channel of the endoscope.
• According to another aspect, an endoscope for removing tissue at a surgical site includes an elongated tubular body having a distal end and a proximal end. The distal end sized to be inserted within a mammalian cavity of a patient. The distal end extends from a distal tip of the elongated tubular body to a portion of the elongated tubular body within which the steerable assembly is disposed. The endoscope includes an instrument channel extends between a first opening at the distal end and a second opening at the proximal end, the instrument channel sized and configured to receive a removable surgical cutting assembly that includes an aspiration channel configured to fluidly couple, at a proximal end of the surgical cutting assembly, to a suction source to remove material entering the endoscope via a distal end of the surgical cutting assembly. The endoscope includes a torque generation component configured to generate torque and positioned within the distal end. The torque generation component configured to provide the generated torque to a coupling component responsive to actuation of the torque generation component. The coupling component is positioned at the distal end of the elongated tubular member, the coupling component configured to actuate a cutting component of the surgical cutting assembly responsive to actuation of the torque generation component.
• According to another aspect, an endoscope for removing tissue at a surgical site, includes an elongated tubular body having a distal end and a proximal end. The distal end is insertable within a mammalian cavity of a patient. The proximal end is configured to remain outside the mammalian cavity of the patient. The endoscope includes an instrument channel defined within the elongated tubular body and extending between a first opening at the proximal end and a second opening at the distal end. The instrument channel is sized and configured to receive a removable surgical cutting assembly that defines an aspiration channel configured to fluidly couple, at a proximal end of the surgical cutting assembly, to a suction source to remove material entering the endoscope via a distal end of the surgical cutting assembly. The endoscope includes a flexible torque delivery component configured to deliver torque generated by a torque generation component to an inner cannula of the surgical cutting assembly to cause the inner cannula to move relative to an outer cannula of the surgical cutting assembly to resect material entering the surgical cutting assembly. The flexible torque delivery component extends from the proximal end towards the distal end of the elongated tubular body. The endoscope includes a coupling component is rotatably coupled to the flexible torque delivery component to provide the torque delivered by the flexible torque delivery component to a coupling member of the surgical cutting assembly and configured to cause the coupling member of the surgical cutting assembly to move the inner cannula relative to the outer cannula upon actuation of the flexible torque delivery component.
• In some implementations, the flexible torque delivery component is one of a flexible torque coil or a flexible torque rope. In some implementations, the flexible torque delivery component includes a plurality of layers of one or more threads, each of the plurality of layers is wound in a direction opposite to a direction in which one or more adjacent layers of the plurality of layers is wound.
• In some implementations, a length of the coupling component is sized to allow the endoscope to be inserted within a mammalian cavity of the patient.
• In some implementations, the coupling component is a magnetic coupler surrounding a distal portion of the instrument channel. The magnetic coupler has a magnetic force sufficient to magnetically couple to a coupling member of the surgical cutting assembly to cause the magnetic coupler of the surgical cutting assembly to move t relative the first portion of the surgical cutting assembly. In some implementations, an inner wall of the coupling component has an inner diameter greater than a diameter of the instrument channel and wherein a portion of the instrument channel is disposed within the coupling component. In some implementations, an outer wall of the coupling component includes frictional elements configured to rotatably engage with the flexible torque delivery component. In some implementations, the flexible torque delivery component has an inner wall having an inner diameter that is greater than an outer diameter of the instrument channel and wherein a portion of the instrument channel is disposed within the inner wall of the flexible torque delivery component, and wherein the coupling component is rotatably coupled to the flexible torque delivery component. The coupling component positioned towards the distal end of the elongated tubular member and configured to magnetically couple to a magnetic coupler of the surgical cutting assembly.
• In some implementations, the endoscope further including a torque delivery component channel defined within the elongated tubular body and extending from a third opening at the proximal end towards the distal end of the elongated tubular body, and wherein the flexible torque delivery component is sized to be disposed within the torque delivery component channel. In some implementations, the flexible torque delivery component is configured to cause an inner cannula of the surgical cutting assembly to rotate relative to an outer cannula of the surgical cutting assembly.
• In some implementations, the flexible torque delivery component is configured to couple to a linear motion assembly that converts the torque delivered from the torque generation component to linear motion. In some implementations, the flexible torque delivery component is configured to rotate in a first direction to cause the coupling component to move from a first position to a second position in a direction from the proximal end to the distal end and to rotate in a second direction to cause the coupling component to move from the second position to the first position, wherein the flexible torque delivery component is configured to alternate between rotating in the first direction and the second direction to cause an inner cannula of the surgical cutting assembly to reciprocate between a first open position in which a distal tip of the inner cannula is a first predetermined distance away from a distal tip of an outer cannula of the surgical cutting assembly and a second closed position in which the distal tip of the inner cannula is less than a second predetermined distance away from the distal tip of the outer cannula, wherein the second predetermined distance is less than the first predetermined distance.
• In some implementations, the instrument channel is defined to receive the surgical cutting assembly for removing tissue, the surgical cutting assembly including the inner cannula coupled to a flexible aspiration tube via the coupling member. In some implementations, the instrument channel is configured to include at least one groove configured to engage with a corresponding key of the surgical cutting assembly to cause a cutting window of the outer cannula of the surgical cutting assembly to be aligned with respect to a camera lens of the endoscope.
• In some implementations, the endoscope can include an articulation assembly configured to engage an outer cannula of the surgical cutting assembly, the articulation assembly configured to cause the outer cannula to rotate relative to the inner cannula. In some implementations, the articulation assembly is configured to rotate the outer cannula between a plurality of predetermined positions.
• In some implementations, the endoscope includes a deployment component configured to be actuated by an actuator. The deployment component configured to maintain the surgical cutting assembly disposed within the tubular body in a first undeployed position and configured to deploy the surgical cutting assembly from the first undeployed position to a second deployed position upon actuation of the deployment component. In some implementations, the deployment component is configured to move between a closed state in which the surgical cutting assembly is maintained in the first undeployed position and an opened state in which the surgical cutting assembly is deployed to the second deployed position. In some implementations, when the surgical cutting assembly is in the second deployed position, an outer cannula of the surgical cutting assembly extending outwardly along a longitudinal axis of the endoscope from the distal end of the endoscope and having a cutting window that is positioned at a distance away from a camera of the endoscope that allows the cutting window to be viewed in an image captured by the camera.
• In some implementations, the endoscope can include an irrigation channel extending from the proximal end to an opening defined within a wall of the tubular body that defines the instrument channel. The irrigation channel is configured to fluidly connect to an irrigation pathway defined within the surgical cutter assembly. The surgical cutting assembly can be configured to allow irrigation fluid entering the proximal end of the endoscope to flow into the irrigation pathway defined between an outer cannula and an inner cannula of the surgical cutter assembly when the surgical cutter assembly is inserted within the instrument channel of the endoscope.
• In some implementations, the coupling component is disposed within a region of the distal end of the endoscope that extends between the distal tip of the elongated tubular body and a portion of the elongated tubular body within which the steerable assembly is disposed.
• According to another aspect, a medical device includes a surgical cutting assembly insertable within an instrument channel of an endoscope having a torque generation component or a torque delivery component disposed within an portion of the endoscope insertable within a mammalian cavity of a patient. The surgical cutting assembly configured to resect material at a surgical site within the mammalian cavity of the patient. The surgical cutting assembly includes an outer cannula including a cutting window and an inner cannula disposed within the outer cannula. The surgical cutting assembly includes a flexible outer tubing coupled to a proximal end of the outer cannula. The inner cannula and the outer tubing having a first length that exceeds a length of the instrument channel of the endoscope within which the surgical cutting assembly is insertable. The surgical cutting assembly includes a coupling member having a distal end coupled to the proximal end of the inner cannula. The surgical cutting assembly includes an aspiration tubing disposed within an inner wall of the flexible outer tubing and fluidly coupled to the inner cannula via the coupling member, wherein the inner cannula, the coupling member and the aspiration tubing having a second length that exceeds the length of the instrument channel of the endoscope within which the surgical cutting assembly is insertable. The inner cannula, the coupling member and the aspiration tubing define an aspiration channel through which the material resected by the surgical cutting assembly is removed from the surgical site within the mammalian cavity of the patient to outside the mammalian cavity. The surgical cutting assembly includes a seal including a stationary portion and a movable portion, the movable portion coupled to the coupling member and the stationary portion coupled to the outer tubing, the seal configured to allow the coupling member to move relative to the outer tubing.
• In some implementations, the coupling member includes one or more magnetic surfaces and is configured to magnetically couple to a magnetic coupling component of the endoscope within which the surgical cutting assembly is insertable. In some implementations, the coupling member is configured to rotate about a longitudinal axis of the inner cannula and wherein the inner cannula is configured to rotate about the longitudinal axis relative to the outer cannula. In some implementations, the coupling member is configured to rotate responsive to the coupling component of the endoscope rotating.
• In some implementations, a length of the inner cannula and the coupling member is greater than a length of the outer cannula. In some implementations, the coupling member is sized to be disposed within the flexible outer tubing.
• In some implementations, the seal includes another portion configured to connect the coupling member to the aspiration tube but rotationally decouple the coupling member and the aspiration tube. In some implementations, the aspiration tubing is configured to be fluidly coupled to a suction source.
• In some implementations, the stationary portion of the seal is an outer wall of the seal. The outer wall of the seal includes frictional elements configured to frictionally engage with the inner wall of the outer tubing. In some implementations, the outer tubing is a braided tubing configured to cause the outer cannula to rotate when a proximal end of the braided tubing extending outside the endoscope within which the surgical cutting assembly is insertable is rotated. In some implementations, the surgical cutting assembly includes at least one of a groove or a key defined on an outer wall of the outer tubing, the groove or key configured to engage with a corresponding key or groove defined within the instrument channel of the endoscope within which the surgical cutting assembly is insertable.
• In some implementations, the surgical cutting assembly includes an irrigation channel. The irrigation channel includes a first irrigation channel portion defined between an inner wall of the outer cannula and an outer wall of the inner cannula and a second irrigation channel portion defined between an inner wall of the outer tubing and an outer wall of the coupling member and an outer wall of the aspiration tubing.
• In some implementations, the surgical cutting assembly includes a lavage connector including an irrigation entry port and a tubular member coupled to the lavage connector and the flexible outer tubing. The aspiration tubing disposed within the tubular member and the outer wall of the aspiration tubing defining a third irrigation channel portion that is fluidly coupled to the first portion of the irrigation channel and the second portion of the irrigation channel. In some implementations, the irrigation channel extends from the irrigation entry port to the cutting window of the outer cannula.
• In some implementations, the irrigation channel of the surgical cutting assembly configured to receive a fluid from an irrigation source, wherein the fluid is one of a topical drug or a therapeutic.
• In some implementations, the irrigation channel is configured to receive the fluid at a first flow rate to provide irrigation fluid to facilitate aspiration and at a second flow rate to spray the irrigation fluid at a site within the mammalian cavity, the irrigation fluid entering the site from the cutting window of the outer cannula. In some implementations, the medical device can include a flow rate management component configured to manage a flow rate at which to deliver the irrigation fluid to the irrigation channel and an aspiration flow rate at which to aspirate material via the aspiration channel. The flow rate management component is configured to reduce the aspiration flow rate responsive to detecting an increase in the irrigation flow rate beyond a threshold irrigation flow rate.
• In some implementations, the outer cannula includes at least one engagement member configured to engage with an articulation assembly defined within the insertable portion of the endoscope. The articulation assembly configured to cause the outer cannula to rotate relative to the endoscope.
• In some implementations, the surgical cutting assembly further includes a rotary seal that connects the outer cannula to the outer tubing and rotationally decouples the outer cannula and the outer tubing.
• In some implementations, the surgical cutting assembly further includes an outer coupling component including at least one magnet configured to magnetically couple to the coupling member. The outer coupling component positioned adjacent to the coupling member and having an inner wall through which the outer tubing and the coupling member are disposed. In some implementations, the outer coupling component is configured to engage with the coupling component of the endoscope, the coupling component of the endoscope configured to cause the outer coupling component to move. In some implementations, the coupling component of the endoscope is configured to physically engage with the outer coupling component of the surgical cutting assembly to cause the outer coupling component to move relative to the outer tubing of the surgical cutting assembly.
• In some implementations, the coupling member of the surgical cutting assembly has a first length extending from a first end coupled to the inner cannula and a second end coupled to the aspiration tube. The first length is greater than a corresponding length of the coupling component of the endoscope within which the surgical cutting assembly is insertable. In some implementations, the coupling member is configured to be rotatably coupled to the coupling component over a distance that extends from a first position where the first end of the inner cannula is adjacent to a proximal end of the coupling component to a second position where the second end of the coupling member is adjacent to a distal end of the coupling component.
• In some implementations, the coupling member of the surgical cutting assembly can have a first length extending from a first end coupled to the inner cannula and a second end coupled to the aspiration tube that is less than a corresponding length of the coupling component of the endoscope within which the surgical cutting assembly is insertable. In some such implementations, the coupling member is configured to be rotatably coupled to the coupling component over a distance that extends from a first position where the distal end of the inner cannula is adjacent to a proximal end of the coupling component to a second position where the second end of the coupling member is adjacent to a distal end of the coupling component.
• In some implementations, the coupler is a first coupler and the surgical cutting assembly further including a second coupler configured to couple the outer cannula to the coupling member, the first coupler and the second coupler configured to allow the coupling member to rotate relative to the outer tubing and the outer cannula. In some implementations, the coupling member is configured to contact a coupling component of the endoscope within which the surgical cutting assembly is insertable and configured to rotate when the coupling component rotates.
• According to yet another aspect, a method of retrieving lesions from a mammalian cavity of a patient, includes inserting a flexible endoscope within an opening to a mammalian cavity of a patient. An endoscopic instrument is disposed or inserted within an instrument channel of the flexible endoscope to resect at least a portion of a lesion from within the mammalian cavity. The endoscopic instrument including a cutting assembly having an outer cannula, an inner cannula disposed within an outer cannula, and a cutting window defined along a portion of a radial wall of the outer cannula, the inner cannula rotatably coupled to a flexible torque component having a length that extends along a length of the flexible endoscope, the flexible torque component, upon actuation, providing torque to the inner cannula to rotate relative to the outer cannula to resect the portion of the lesion. Irrigation fluid is then provided from a lavage port of the endoscopic instrument that remains outside the flexible endoscope while the endoscopic instrument is disposed within the instrument channel. The lavage port is fluidly coupled to the outer cannula through a rotational coupler coupling the lavage port to an outer tubing connected to the outer cannula. The rotational coupler can allow the outer tubing and the outer cannula to rotate relative to the lavage port upon rotating a portion of the rotational coupler. The outer cannula is then rotated, via rotation of the portion of the rotational coupler, to a position in which the opening of the outer cannula is viewable via a camera of the flexible endoscope. The cutting window of the outer cannula is then positioned at the lesion of the mammalian cavity. The flexible torque component is then actuated to rotate the inner cannula relative to the outer cannula, the inner cannula cutting the portion of the lesion as the inner cannula rotates adjacent to the cutting window. A sample retrieval component of the surgical cutting assembly is actuated to remove the cut portions of the lesion from within the mammalian cavity via an aspiration channel defined by an inner wall of the inner cannula and the flexible torque component.
• In some implementations, disposing the endoscopic instrument within the instrument channel of the flexible endoscope includes inserting a distal end of the endoscopic instrument in the instrument channel of the flexible endoscope.
• In some implementations, a proximal connector that is coupled to the flexible torque component and positioned at a proximal end of the endoscopic instrument is engaged with a drive assembly configured to provide torque to the flexible torque component.
• In some implementations, a vacuum source is fluidly coupled to a distal end of the endoscopic instrument to remove, from the endoscopic instrument, portions of the lesion entering the endoscopic instrument via the opening of the outer cannula.
• In some implementations, the flexible torque component includes a flexible torque coil having a plurality of layers of one or more threads, each of the plurality of layers is wound in a direction opposite to a direction in which one or more adjacent layers of the plurality of layers is wound and the aspiration channel is partially defined by an inner wall of the flexible torque coil.
• In some implementations, actuating the flexible torque component and actuating the sample retrieval component of the endoscopic instrument includes actuating the flexible torque component and actuating the sample retrieval component of the endoscopic instrument simultaneously.
• In some implementations, actuating the flexible torque component includes providing torque to the inner cannula that is sufficient to cut at least a portion of the lesion. In some implementations, actuating the flexible torque component includes actuating the flexible torque component to cause an inner cannula of the cutting assembly to rotate relative to the outer cannula via a foot pedal.
• In some implementations, the lesion is a first lesion and the mammalian cavity is a colon. Upon cutting at least a portion of the first lesion and without removing the endoscopic instrument from the flexible endoscope, the opening of the outer cannula is positioned at a second lesion within the colon. The flexible torque component is actuated to rotate the inner cannula relative to the outer cannula, the inner cannula cutting at least a portion of the second lesion. The sample retrieval component of the endoscopic instrument is actuated to remove the cut portion of the second lesion from within the colon.
• According to another aspect, a method of removing lesions from within a patient, includes inserting a flexible endoscope within an opening of a patient, disposing an endoscopic instrument within an instrument channel of the flexible endoscope to remove a lesion from the surgical site, the endoscopic instrument including a cutting assembly having an outer cannula, an inner cannula disposed within an outer cannula, and an opening defined along a portion of a radial wall of the outer cannula, the inner cannula rotatably coupled to a flexible torque component having a length that extends along a length of the flexible endoscope, the flexible torque component, upon actuation, providing torque to the inner cannula, positioning the opening of the outer cannula at the lesion, actuating the flexible torque component to rotate the inner cannula relative to the outer cannula, the inner cannula cutting a portion of the lesion as the inner cannula rotates adjacent to the opening, and actuating a sample retrieval component of the endoscopic instrument to remove the cut portions of the lesion from within the patient via an aspiration channel defined by an inner wall of the inner cannula and the flexible torque component.
• In some implementations, the method includes providing irrigation fluid from a lavage port of the endoscopic instrument that remains outside the flexible endoscope while the endoscopic instrument is disposed within the instrument channel. The lavage port is fluidly coupled to the outer cannula through a rotational coupler coupling the lavage port to an outer tubing connected to the outer cannula, the rotational coupler allowing the outer tubing and the outer cannula to rotate relative to the lavage port upon rotating a portion of the rotational coupler.
• In some implementations, the method includes rotating, via rotation of the portion of the rotational coupler, the outer cannula to a position in which the opening of the outer cannula is viewable via a camera of the flexible endoscope.
• In some implementations, disposing the endoscopic instrument within the instrument channel of the flexible endoscope includes inserting a distal end of the endoscopic instrument in the instrument channel of the flexible endoscope.
• In some implementations, the method includes engaging a proximal connector that is coupled to the flexible torque component and positioned at a proximal end of the endoscopic instrument with a drive assembly configured to provide torque to the flexible torque component.
• In some implementations, the method includes fluidly coupling a vacuum source to a distal end of the endoscopic instrument to remove, from the endoscopic instrument, cut portions of the lesion entering the endoscopic instrument via the opening of the outer cannula.
• In some implementations, the flexible torque component includes a flexible torque coil having a plurality of layers of one or more threads, each of the plurality of layers is wound in a direction opposite to a direction in which one or more adjacent layers of the plurality of layers is wound and the aspiration channel is partially defined by an inner wall of the flexible torque coil.
• In some implementations, actuating the flexible torque component and actuating a sample retrieval component of the endoscopic instrument includes actuating the flexible torque component and actuating the sample retrieval component of the endoscopic instrument simultaneously.
• In some implementations, actuating the flexible torque component includes providing torque to the inner cannula that is sufficient to cut at least a portion of the lesion. In some implementations, actuating the flexible torque component includes actuating the flexible torque component to cause an inner cannula of the cutting assembly to rotate relative to the outer cannula via a foot pedal.
• In some implementations, the lesion is a first lesion and the method further includes upon cutting at least a portion of the first lesion and without removing the endoscopic instrument from the flexible endoscope, positioning the opening of the outer cannula at a second lesion at another surgical site, actuating the flexible torque component to rotate the inner cannula relative to the outer cannula, the inner cannula cutting at least a portion of the second lesion, and actuating the sample retrieval component of the endoscopic instrument to remove the cut portion of the second lesion from within the patient.
• According to another aspect, a method of resecting a lesion from within a mammalian cavity of a patient, includes inserting a flexible endoscope within an opening to a mammalian cavity of a patient, the flexible endoscope including a coupling component disposed within a distal end of the endoscope, the flexible endoscope inserted within the opening via the distal end. The method includes disposing a surgical cutting assembly within an instrument channel of the flexible endoscope. The surgical cutting assembly inserted into the instrument channel via an instrument channel opening to the instrument channel at a proximal end of the endoscope that remains outside the opening to the mammalian cavity. The surgical cutting assembly including a cutter assembly having an outer cannula, an inner cannula disposed within an outer cannula, and a cutting window defined along a portion of a radial wall of the outer cannula, a proximal end of the inner cannula coupled to a coupling member, the coupling member fluidly coupled to an aspiration tube that extends along a length of the flexible endoscope, the coupling member configured to rotatably couple with the coupling component of the flexible endoscope. The method includes positioning, by rotating the outer cannula of the surgical cutting assembly, the cutting window at the lesion within the mammalian cavity to be resected. The method includes providing torque to the coupling component of the endoscope. The torque provided by one of a torque generation component disposed within the distal end of the endoscope or via a flexible torque component extending from the proximal end of the endoscope to the distal end of the endoscope. The torque causing the coupling component of the endoscope to rotate and cause the coupling member of the surgical cutting assembly and the inner cannula to rotate relative to the outer cannula to resect at least a portion of the lesion at the cutting window of the outer cannula. The method includes actuating a sample retrieval component to provide suction to the aspiration tube to remove the resected portion of the lesion via an aspiration channel defined by an inner wall of the inner cannula, an inner wall of the coupling member and the aspiration tube.
• In some implementations, the method includes actuating the torque generation component. In some implementations, actuating the torque generation component includes providing a fluid to the torque generation component via a fluid entry channel and removing the fluid from the torque generation component via a fluid exit channel. In some implementations, actuating the torque generation component includes providing an electric current to the torque generation component via an electrical wire that extends from the torque generation component to a current source outside the flexible endoscope.
• In some implementations, the method includes actuating a rotary actuator positioned outside the endoscope and connected to the torque delivery component. The torque delivery component is configured to deliver the torque generated by the rotary actuator to the coupling component. The torque delivery component includes a flexible torque coil or flexible torque rope having a plurality of layers of one or more threads. Each of the plurality of layers is wound in a direction opposite to a direction in which one or more adjacent layers of the plurality of layers is wound.
• In some implementations, the coupling component includes at least one magnet and the method further includes magnetically coupling the coupling component of the endoscope and the coupling member of the endoscope.
• In some implementations, the method further includes providing irrigation fluid to the surgical cutting assembly via an irrigation fluid delivery channel defined within the endoscope, the irrigation fluid delivery channel including an entry port at a proximal end of the endoscope and a fluid exit port positioned towards the distal end of the endoscope and fluidly coupled to an irrigation entry opening of the surgical cutting assembly, the irrigation entry opening of the surgical cutting assembly fluidly coupled to an irrigation pathway defined between the outer cannula and the inner cannula of the cutter assembly.
• In some implementations, a portion of the irrigation fluid delivery channel is positioned adjacent to at least one of the torque generation component, the coupling component or the torque delivery component to provide a cooling effect to the torque generation component, the coupling component or the torque delivery component.
• In some implementations, positioning, by rotating the outer cannula of the surgical cutting assembly, the cutting window at the lesion within the mammalian cavity to be resected includes actuating an articulation assembly disposed at the distal end of the endoscope, the articular assembly configured to engage with the outer cannula and configured to cause the outer cannula to rotate relative to the endoscope.
• In some implementations, positioning, by rotating the outer cannula of the surgical cutting assembly, the cutting window at the lesion within the mammalian cavity to be resected includes rotating an outer tubing coupled to the outer cannula, the outer tubing configured to cause the outer cannula to rotate relative to the endoscope based on rotating the outer tubing.
• This Summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description. This Summary is not intended to identify key features or essential features of the claimed subject matter, nor is it intended that this Summary be used to limit the scope of the claimed subject matter. Furthermore, the claimed subject matter is not limited to implementations that offer any or all advantages or solve any or all state of the art problems.
BRIEF DESCRIPTION OF THE DRAWINGS
• The present disclosure is illustratively shown and described in reference to the accompanying drawing in which:
• FIG. 1A illustrates various types of polyps that can form within a body.
• FIG. 1B illustrates a perspective partial view of an endoscope according to embodiments of the present disclosure.
• FIG. 1C illustrates a perspective view of an endoscopic instrument according to embodiments of the present disclosure.
• FIGS. 2A and 2B illustrate side perspective views of an endoscopic instrument coupled with the endoscope shown inFIG. 1 according to embodiments of the present disclosure.
• FIGS. 3A and 3B illustrate side perspective views of an example endoscopic instrument coupled with the endoscope shown inFIG. 1 according to embodiments of the present disclosure.
• FIG. 4A illustrates an exploded view of the endoscopic instrument that can be coupled with the endoscope according to embodiments of the present disclosure.
• FIG. 4B illustrates a perspective view diagram of the endoscopic instrument coupled to the endoscope illustrating the various conduits associated with the endoscopic instrument.
• FIG. 5 illustrates a side perspective view of another example endoscopic instrument coupled with the endoscope shown inFIG. 1 according to embodiments of the present disclosure.
• FIG. 6 illustrates an enlarged view of an example endoscopic instrument according to embodiments of the present disclosure.
• FIG. 7 illustrates a perspective view of an outer blade of a cutting tool of the endoscopic instrument shown inFIG. 6 according to embodiments of the present disclosure.
• FIG. 8 illustrates a perspective view of an inner blade of the cutting tool of the endoscopic instrument shown inFIG. 6 according to embodiments of the present disclosure.
• FIG. 9 illustrates a perspective view of a rotor of the endoscopic instrument shown inFIG. 6 according to embodiments of the present disclosure.
• FIG. 10 illustrates a perspective view of a casing of the endoscopic instrument shown inFIG. 6 according to embodiments of the present disclosure.
• FIG. 11 illustrates a perspective view of a cap of the endoscopic instrument shown inFIG. 6 according to embodiments of the present disclosure.
• FIG. 12 illustrates a perspective view of a coupling member of the endoscopic instrument shown inFIG. 6 according to embodiments of the present disclosure.
• FIG. 13 illustrates a perspective view diagram of the endoscopic instrument coupled to the endoscope illustrating the various conduits associated with the endoscopic instrument.
• FIG. 14 illustrates another perspective view diagram of the endoscopic instrument coupled to the endoscope illustrating the various conduits associated with the endoscopic instrument.
• FIG. 15 is a conceptual system architecture diagram illustrating various components for operating the endoscopic instrument according to embodiments of the present disclosure.
• FIG. 16A illustrates an exploded view of an example endoscopic instrument according to embodiments of the present disclosure.
• FIG. 16B illustrates a cross-sectional view of the endoscopic instrument shown inFIG. 16A according to embodiments of the present disclosure.
• FIG. 16C illustrates a schematic view of an example engagement assembly of an example endoscopic instrument according to embodiments of the present disclosure.
• FIG. 16D shows a cut-open view of the engagement assembly shown inFIG. 16C when the engagement assembly is disengaged according to embodiments of the present disclosure.
• FIG. 16E shows a cut-open view of the engagement assembly shown inFIG. 16A when the engagement assembly is configured to engage with an instrument channel of an endoscope according to embodiments of the present disclosure.
• FIG. 17A illustrates an exploded view of an example endoscopic instrument according to embodiments of the present disclosure.
• FIG. 17B illustrates a cross-sectional view of the endoscopic instrument shown inFIG. 17A according to embodiments of the present disclosure.
• FIG. 18A illustrates an exploded view of an example endoscopic instrument utilizing a tesla rotor according to embodiments of the present disclosure.
• FIG. 18B illustrates a cross-sectional view of the endoscopic instrument shown inFIG. 18A according to embodiments of the present disclosure.
• FIG. 19A illustrates an example endoscopic instrument that is coupled to a powered actuation and vacuum system according to embodiments of the present disclosure.
• FIG. 19B illustrates a cross-section view of the powered actuation and vacuum system shown inFIG. 19A according to embodiments of the present disclosure.
• FIG. 19C illustrates an exploded view of an example head portion of the endoscopic instrument shown inFIG. 19A according to embodiments of the present disclosure.
• FIG. 19D illustrates a cut-open view of a portion of the endoscopic instrument having an engagement assembly according to embodiments of the present disclosure
• FIG. 19E shows a cut-open view of the engagement assembly shown inFIG. 19D in a disengaged position according to embodiments of the present disclosure.
• FIG. 19F shows a cut-open view of the engagement assembly shown inFIG. 19D in an engaged position according to embodiments of the present disclosure.
• FIG. 20 is a conceptual system architecture diagram illustrating various components for operating the endoscopic instrument according to embodiments of the present disclosure.
• FIGS.21AA-21F illustrate aspects of an endoscopic assembly according to embodiments of the present disclosure.
• FIGS. 22A-22H show various implementations of example flexible cables according to embodiments of the present disclosure.
• FIGS.23AA-23BB show an example implementation of a cutting tool according to embodiments of the present disclosure.
• FIGS. 24A-24C illustrate various aspects of the drive shaft of the coupling component according to embodiments of the present disclosure.
• FIG. 25 illustrates an example housing component according to embodiments of the present disclosure.
• FIGS. 26A-26E show an example sleeve bearing according to embodiments of the present disclosure.
• FIGS. 27A-27C show an example base plate that forms a portion of the casing according to embodiments of the present disclosure.
• FIGS. 28A-28D show an example side plate that forms a portion of the casing according to embodiments of the present disclosure.
• FIGS.29AA-29EE show various aspects of ferrules according to embodiments of the present disclosure
• FIGS.30AA-30C illustrate aspects of an endoscopic assembly in which the tip is press-fit according to embodiments of the present disclosure.
• FIGS.31AA-31AB and31B-31C illustrate aspects of an endoscopic assembly in which the tip is press-fit according to embodiments of the present disclosure.
• FIG. 32 shows a top view of an example flexible portion of an endoscopic tool according to embodiments of the present disclosure.
• FIG. 33 is a cross-sectional view of an example cutting assembly of an endoscopic tool using a torque rope according to embodiments of the present disclosure.
• FIGS. 34A-34C are cross-sectional views of different configurations of the flexible portion region of one implementation of an endoscopic tool described herein.
• FIGS.35AA-AC show various views of portions of an endoscopic tool according to embodiments of the present disclosure.
• FIG. 36 shows a cross-sectional view of the flexible portion region of one implementation of an endoscopic tool according to embodiments of the present disclosure.
• FIG. 37 shows a cross-section view of one implementation of the endoscopic tool according to embodiments of the present disclosure.
• FIGS. 38A and 38B show various views of a distal portion of one implementation of an endoscopic tool according to embodiments of the present disclosure.
• FIGS. 39A and 39B show cross-sectional views of the distal portion of the endoscopic tool shown inFIGS. 38A and 38B along the sections B-B and sections C-C according to embodiments of the present disclosure.
• FIGS. 40A-40B show a perspective view of an endoscopic tool and a portion of a drive assembly configured to drive the endoscopic tool according to embodiments of the present disclosure.
• FIG. 41 shows a top view of the endoscopic tool and a top exposed view of the portion of the drive assembly shown inFIGS. 40A-40B according to embodiments of the present disclosure.
• FIG. 42 shows a cross-sectional view of the endoscopic tool and the portion of the drive assembly across the section A-A shown inFIGS. 40A-40B according to embodiments of the present disclosure.
• FIG. 43 shows an enlarged view of the drive connector of the endoscope and the portion of the drive assembly shown inFIGS. 40A-40B according to embodiments of the present disclosure.
• FIG. 44 shows a perspective view of the endoscopic tool and a portion of the drive assembly shown inFIGS. 40A-40B according to embodiments of the present disclosure.
• FIG. 45 shows a cross-sectional view of the endoscopic tool and the portion of the drive assembly across the section B-B according to embodiments of the present disclosure.
• FIG. 46 shows an enlarged cross-sectional view of the rotational coupler section of the endoscopic tool according to embodiments of the present disclosure.
• FIG. 47A andFIG. 47B show a top view and a cross-sectional view of the rotational coupler of the endoscopic tool according to embodiments of the present disclosure.
• FIG. 48 is a perspective view of a portion of the endoscopic tool inserted for operation within a drive assembly according to embodiments of the present disclosure.
• FIG. 49 illustrates another implementation of the endoscopic tool and a drive assembly configured to drive the endoscopic tool according to embodiments of the present disclosure.
• FIG. 50A is a side view of the endoscopic tool and drive assembly shown inFIG. 49 according to embodiments of the present disclosure.
• FIG. 50B is a cross-sectional view of the endoscopic tool and drive assembly shown inFIG. 49 taken along the section A-A according to embodiments of the present disclosure.
• FIG. 51 is perspective view of an endoscope including an integrated torque generation component or a torque delivery component according to embodiments of the present disclosure.
• FIG. 52A is a top view of a distal end of an endoscopic assembly including the endoscope shown inFIG. 51 and a surgical cutting assembly inserted within an instrument channel of the endoscope according to embodiments of the present disclosure.
• FIG. 52B is a cross-sectional view of a portion of the endoscopic assembly along the reference line B-B shown inFIG. 52A.
• FIG. 53A is a perspective view of the portion of the endoscopic assembly shown inFIG. 51.
• FIG. 53B is a cross-sectional view of the portion of the endoscopic assembly shown inFIG. 53A.
• FIG. 53C is an enlarged cross-sectional view of the portion of the endoscopic assembly shown inFIG. 53A.
• FIG. 53D is a perspective view of a surgical cutting assembly inserted in the endoscope shown inFIG. 53A.
• FIG. 53E is a cross-sectional view of a portion of the surgical cutting assembly shown inFIG. 53D.
• FIG. 53F is a side cross-sectional view of the surgical cutting assembly shown inFIG. 53D.
• FIG. 54A is a cross-sectional perspective view of a portion of an endoscopic assembly including an endoscope and a surgical cutting assembly in which an endoscope includes an integrated torque generation component according to embodiments of the present disclosure.
• FIG. 54B is an enlarged view of the torque generation component of the endoscope shown inFIG. 54A.
• FIG. 55A is a perspective view of a portion of an endoscopic assembly including an endoscope and a surgical cutting assembly in which the endoscope includes an integrated torque delivery component according to embodiments of the present disclosure.
• FIG. 55B is a cross-sectional perspective view of the portion of the endoscope shown inFIG. 55A and a surgical cutting assembly inserted in the endoscope according to embodiments of the present disclosure.
• FIG. 56A is a perspective view of a portion of an endoscopic assembly including an endoscope having an integrated torque generation assembly capable of causing a surgical cutting assembly inserted within the endoscope to cut tissue in a reciprocating motion according to embodiments of the present disclosure.
• FIG. 56B is an enlarged perspective view of the torque generation assembly shown inFIG. 56A.
• FIGS. 57A-57C is a side perspective view of a portion of an endoscopic assembly including an endoscope and a surgical cutting assembly inserted within the endoscope to cut tissue in a reciprocating motion according to embodiments of the present disclosure.
• FIG. 58A is a perspective cross-sectional view of an endoscopic assembly including an endoscope and a surgical cutting assembly in which the endoscope is configured to rotate an outer cannula of the surgical cutting assembly using an actuator according to embodiments of the present disclosure.
• FIG. 58B is a perspective view of a component of the endoscope for rotating the outer cannula of the surgical cutting assembly shown inFIG. 58A.
• FIG. 59A is a perspective view of the surgical cutting assembly shown inFIG. 58A.
• FIG. 59B is a perspective cross-sectional view of the surgical cutting assembly shown inFIG. 58A.
• FIG. 60A is a perspective view of a surgical cutting assembly according to embodiments of the present disclosure.
• FIG. 60B is a perspective cross-sectional view of the surgical cutting assembly shown inFIG. 60A.
• FIG. 61 shows an endoscopic assembly that includes the endoscope shown inFIG. 53B and a surgical cutting assembly similar to the surgical cutting assembly shown inFIG. 53B.
• FIG. 62 is a flow chart depicting a method for resecting material from within a mammalian cavity of a patient.
• FIG. 63A is a perspective view of a distal portion of a surgical cutting assembly according to embodiments of the present disclosure.
• FIG. 63B is an exploded view of the distal portion surgical cutting assembly shown inFIG. 63A.
• FIG. 63C is a perspective cross-sectional view of the distal portion of the surgical cutting assembly shown inFIG. 63A.
• FIG. 63D is an enlarged view of a portion ofFIG. 63B including the first coupler of the surgical cutting assembly shown inFIG. 63A.
• FIG. 63E is an enlarged view of a portion ofFIG. 63B including the second coupler of the surgical cutting assembly shown inFIG. 63A.
• FIG. 63F is a side view of the second coupler of the surgical cutting assembly shown inFIG. 63A.
• FIG. 63G shows a perspective view of the surgical cutting assembly ofFIG. 63A including the coupling member in a first position.
• FIG. 63H shows a perspective view of the surgical cutting assembly ofFIG. 63A including the coupling member at a second position.
• FIG. 64A is a perspective cross-sectional view of an endoscopic assembly including an endoscope and the surgical cutting assembly shown inFIG. 63A according to embodiments of the present disclosure.
• FIG. 64B is a perspective view of a distal portion of the endoscope shown inFIG. 64A.
• FIG. 64C is a perspective view of the endoscopic assembly shown inFIG. 64A.
• FIG. 64D is a perspective view of a distal tip of the endoscope shown inFIG. 64A.
• FIG. 65 is a cross-sectional view of a surgical cutting assembly according to embodiments of the present disclosure.
DETAILED DESCRIPTION
• Technologies provided herein are directed towards an improved flexible endoscopic instrument that can precisely and efficiently obtain samples of single and multiple polyps and neoplasms from a patient. In particular, the improved endoscopic instrument is capable of debriding samples from one or more polyps and retrieving the debrided samples without having to remove the endoscopic instrument from the treatment site within the patient's body.
• FIG. 1A illustrates various types of polyps that can form within a body. Most polyps may be removed by snare polypectomy, though especially large polyps and/or sessile or flat polyps must be removed piecemeal with biopsy forceps or en bloc using endoscopic mucosal resection (EMR). A recent study has concluded that depressed sessile polyps had the highest rate for harboring a malignancy at 33%. The same study has also found that non-polypoid neoplastic lesions (sessile polyps) accounted for 22% of the patients with polyps or 10% of all patients undergoing colonoscopy. There are multiple roadblocks to resecting colon polyps, namely the difficulties in removing sessile polyps, the time involved in removing multiple polyps and the lack of reimbursement differential for resecting more than one polyp. Since resecting less accessible sessile polyps presents challenges and multiple polyps take more time per patient, most polyps are removed piece meal with tissue left behind as polyps increase in size, contributing to a sampling bias where the pathology of remaining tissue is unknown, leading to an increase in the false negative rate.
• Colonoscopy is not a perfect screening tool. With current colonoscopy practices the endoscopist exposes the patient to sample bias through removal of the largest polyps (stalked polyps), leaving behind less detectable and accessible sessile/flat polyps. Sessile polyps are extremely difficult or impossible to remove endoscopically with current techniques and often are left alone. An estimated 28% of stalked polyps and 60% of sessile (flat) polyps are not detected, biopsied or removed under current practice, which contributes to sample bias and a 6% false-negative rate for colonoscopy screening. Current colonoscopy instruments for polyp resection are limited by their inability to adequately remove sessile polyps and inefficiency to completely remove multiple polyps. According to the clinical literature, sessile polyps greater than 10 mm have a greater risk of malignancy. Sessile polyp fragments that are left behind after incomplete resection will grow into new polyps and carry risks for malignancy.
• In the recent past, endoscopic mucosal resection (EMR) has been adopted to remove sessile polyps. EMR involves the use of an injection to elevate surrounding mucosa followed by opening of a snare to cut the polyp and lastly use of biopsy forceps or a retrieval device to remove the polyp. The introduction and removal of the injection needle and snare through the length of the colonoscope, which is approximately 5.2 feet, must be repeated for the forceps.
• The present disclosure relates to an endoscopic tool that is capable of delivering an innovative alternative to existing polyp removal tools, including snares, hot biopsy and EMR, by introducing a flexible powered instrument that that works with the current generation colonoscopes and can cut and remove any polyp. The endoscopic tool described herein can be designed to enable physicians to better address sessile or large polyps as well as remove multiple polyps in significantly less time. Through the adoption of the endoscopic tool described herein, physicians can become more efficient at early diagnosis of colorectal cancer.
• The present disclosure will be more completely understood through the following description, which should be read in conjunction with the drawings. In this description, like numbers refer to similar elements within various embodiments of the present disclosure. Within this description, the claims will be explained with respect to embodiments. The skilled artisan will readily appreciate that the methods, apparatus and systems described herein are merely exemplary and that variations can be made without departing from the spirit and scope of the disclosure.
• Referring back to the drawings,FIG. 1B illustrates a perspective partial view of an endoscope according to embodiments of the present disclosure. Although the present disclosure is directed towards endoscopic instruments adapted for use with any type of endoscope, for sake of convenience, the teachings of the present disclosure are directed towards endoscopic instruments used with a lower GI scope, such as a colonoscope. It should, however, be appreciated that the scope of the present disclosure is not limited to endoscopic instruments for use with GI scopes, but extends to any type of flexible endoscope, including but not limited to bronchoscopes, gastroscopes and laryngoscopes, or other medical devices that may be used to treat patients.
• According to various embodiments, a typicallower GI scope100 includes a substantially flexible member that extends from a first end orhead portion102 to a second end or handle portion. Thehead portion102 may be configured to swivel so as to orient atip104 of thehead portion102 in any direction within a hemispherical space. The handle portion has controls that allows the operator of theendoscope100 to steer the colonoscope towards an area of interest within the colon and turn the corners between colon segments with two steering wheels.
• A series of instruments reside on theface106 of the scope'stip104, including but not limited to, one ormore water channels108A-108N, generally referred to as water channels108, for irrigating the area with water, one or morelight sources110A-110N, generally referred to as light sources110, acamera lens112, and aninstrument channel120 through which an endoscopic instrument can be passed through to conduct a number of operations. Theinstrument channel120 can vary in size based on the type ofendoscope100 being used. In various embodiments, the diameter of theinstrument channel120 can range from about 2 mm to 6 mm, or more specifically, from about 3.2 mm to 4.3 mm. Some larger scopes may have twoinstrument channels120 so that two tools can be passed into the patient simultaneously. However, larger scopes may cause discomfort to the patient and may be too large to enter the patient's body through some of the smaller cavities.
• FIG. 1C illustrates a perspective view of anendoscopic instrument150 according to embodiments of the present disclosure. Theendoscopic instrument150 is configured to be fed through theinstrument channel120 of theendoscope100 depicted inFIG. 1B. Theendoscopic instrument150 is configured to be inserted within an instrument channel of an endoscope, such as theinstrument channel120 of theendoscope100 depicted inFIG. 1B. In some implementations, the portion of theendoscopic instrument150 that is configured to be inserted within theinstrument channel120 may be sized to have an outer diameter that is smaller than the inner diameter of theinstrument channel120 of the endoscope. In some such implementations, theendoscopic instrument150 can be sized to have an outer diameter that is sufficiently small to be slidably inserted within the instrument channel while the endoscope is coiled or bent. When the endoscope is coiled or bent, the instrument channel can form a tortuous path that includes one or more curves and bends. In one example implementations, an endoscope includes an instrument channel that has an inner diameter of about 4.3 mm when the endoscope is straightened. However, when the endoscope is coiled or bent, portions of the endoscope near the bends can have clearances that are smaller than the inner diameter of about 4.3 mm. In some implementations, the endoscope can have clearances that may be about 3.8 mm instead of the 4.3 mm achieved when the endoscope is straightened. In some implementations, the endoscope can have clearances that may be about 3.2 mm. As such, in some implementations, theendoscopic instrument150 may be sized such that it can be slidably inserted within the instrument channel of the endoscope with which it is to be used even when the endoscope is coiled or bent.
• In some implementations, theendoscopic instrument150 includes a power-driveninstrument head160 configured to resect material at a site within a subject. The power-driveninstrument head160 has adistal end162 and aproximal end161. Thedistal end162 of the power-driveninstrument head160 defines amaterial entry port170 through which the resected material can enter theendoscopic instrument150. The power-driveninstrument head160 can include a cutting section at thedistal end162 that is configured to cut tissue and other material. As used herein, a port can include any opening, aperture, or gap through which material can either enter or exit. In some implementations, the material entry port can be an opening through which resected material can enter theendoscopic instrument150. In some implementations, material to be resected can be suctioned into the material entry port where the instrument head can then resect the material.
• Abody152 includes ahead portion155 and aflexible portion165. Adistal end156 of thehead portion155 of thebody152 is coupled to theproximal end161 of the power-driveninstrument head160. In some implementations, thehead portion155 of thebody152 is configured to drive the power-driveninstrument head160. Aproximal end158 of thehead portion155 can be coupled to adistal end166 of theflexible portion165. Aproximal end176 of theflexible portion165 defines amaterial exit port175. Theflexible portion165 can include a hollow flexible tubular member.
• The endoscopic instrument also includes an aspiration channel that extends from thematerial entry port170 of the power-driveninstrument head160 to thematerial exit port175 of theflexible portion165. In some implementations, the aspiration channel is defined by the power-driveninstrument head160, thehead portion155 of thebody152 and theflexible portion165 of the body. Theproximal end176 of theflexible portion165 is configured to couple to a vacuum source such that the resected material entering the aspiration channel via thematerial entry port170 is removed from the aspiration channel at thematerial exit port175 while theendoscopic instrument150 is disposed within an instrument channel of an endoscope.
• Thehead portion155 includes a housing that has an outer diameter that is configured such that theendoscopic instrument150 can be slidably inserted into an instrument channel of an endoscope. In some implementations, thehead portion155 can include a powered actuator that is configured to drive the power-driveninstrument head160. In some implementations, the powered actuator is disposed within thehead portion155. In some implementations, the powered actuator is located external to the portion of theendoscopic instrument150 that can be inserted into an instrument channel of an endoscope. In some implementations, the powered actuator is capable of driving the power-driven instrument head via a shaft that can translate motion generated by the power actuator to the power-driven instrument head. In some implementations, the powered actuator is not a part of theendoscopic instrument150, but instead, is coupled to the power-driveninstrument head160. In some implementations, the shaft may be a flexible shaft. In some such implementations, the flexible shaft can be a flexible torque coil, additional details of which are provided below with respect toFIGS. 19A-19C.
• Theendoscopic instrument150 can be sized to be insertable within an instrument channel of an endoscope. In some implementations, theendoscopic instrument150 may be sized such that the endoscopic instrument can be inserted within the instrument channel of the endoscope while the endoscope is inserted within a subject. In some such implementations, the endoscope, for example, a colonoscope, may be curved or bent thereby requiring theendoscopic instrument150 to be sized such that it can be inserted into a curved or bent endoscope.
• In some implementations, thehead portion155 and the power-driveninstrument head160 of theendoscopic instrument150 may be substantially stiff or rigid, while theflexible portion165 may be relatively flexible or compliant. Thehead portion155 and the power-driveninstrument head160 can be substantially rigid. As such, in some such implementations, thehead portion155 and the power-driveninstrument head160 may be sized, at least in thickness and in length, such thatendoscopic instrument150 can maneuver through sharp bends and curves during insertion of theendoscopic instrument150 within the instrument channel of the endoscope. In some implementations, the length of the power-driveninstrument head160 may be between about 0.2″-2″, about 0.2″ and 1″ or in some implementations, between 0.4″ and 0.8″. In some implementations, the outer diameter of the power-driveninstrument head160 may be between about 0.4″-1.5″, 0.6″ and 1.2″ and 0.8″ and 1″. In some implementations, the length of thehead portion155 of the body may be between about 0.5″-3″, about 0.8″ and 2″ and 1″ and 1.5″.
• The length of theflexible portion165 may be substantially and/or relatively longer than the length of the head portion and the power-driveninstrument head160. In some implementations, theflexible portion165 can be sufficiently long such that the combined length of the endoscopic instrument exceeds the length of instrument channel of an endoscope in which the instrument can be inserted. As such, the length of theflexible portion165 may have a length that exceeds about 36″, about 45″ or about 60″. For endoscopic instruments configured for use with other types of endoscopes, the length of the flexible portion may be shorter than 36″, but still sufficiently long to allow for the body of the endoscopic instrument to be approximately the same length or greater than the length of the endoscope with which the instrument is being used.
• The outer diameter of theflexible portion165 can also be configured such that the endoscopic instrument can be inserted into the instrument channel of the endoscope. In some implementations, the outer diameter of theflexible portion165 can be sized smaller than a corresponding inner diameter of the instrument channel of the endoscope. In some such implementations, the endoscopic instrument can be sized to have an outer diameter that is sufficiently small to be slidably disposed within the endoscope while the endoscope is coiled or bent. For example, an endoscope can include an instrument channel that has an inner diameter of about 4.3 mm when the endoscope is straightened. However, when the endoscope is coiled or bent, portions of the endoscope near the bends can have clearances that are smaller than the inner diameter of about 4.3 mm. In some implementations, the endoscope can have clearances that may be as low as 3.2 mm. As such, in some implementations, the endoscopic instrument may be sized such that the endoscopic instrument can be slidably inserted within the instrument channel of the endoscope even when the endoscope is coiled or bent.
• FIGS. 2A and 2B and3A and3B illustrate side perspective views of an endoscopic instrument coupled with the endoscope shown inFIG. 1B according to embodiments of the present disclosure. Theendoscopic instrument220 is configured to be fed through theinstrument channel120 of theendoscope100. As shown inFIGS. 2A and 2B, theendoscopic instrument220 is capable of extending outside thetip104 of theendoscope100, whileFIGS. 3A and 3B show that theendoscope tool220 can be retracted within the endoscope such that no part of theendoscopic instrument220 is extending beyond thetip104 of theendoscope100. As will be described in further detail with respect toFIG. 4, theendoscopic instrument220 is capable of cutting or debriding a polyp as well as obtaining the debrided polyp from the treatment site without having to remove theendoscopic instrument220 from theendoscope100.
• FIG. 4A illustrates an exploded view of theendoscopic instrument220 adapted for use with theendoscope100 according to embodiments of the present disclosure. Theendoscopic instrument220 includes a debriding component for debriding polyps grown in the patient's body, and a sample retrieval component for retrieving the debrided polyps from the surgical site. Theendoscopic instrument220 includes atubing410 coupled to acap420. In various embodiments, thecap420 may be sealingly engaged with thetubing410. The cap can be aligned with aspindle430 at a first portion of thespindle430. In various embodiments, thespindle430 may be substantially hollow. Thespindle430 can be coupled to arotor440, which is configured to rotate thespindle430. A second portion of thespindle430 includes aninner blade450 that may be configured to interact with anouter blade460. In some implementations, theouter blade460 can be separated from the inner blade by a gap that forms an irrigation channel (not shown). Acasing470 is configured to encompass thecap420 and therotor440, as shown above with respect toFIGS. 2A and 3A. It should be appreciated that other components, such as washers, bearings, seals, and the like, may be included in theendoscopic instrument220.
• FIG. 4B is a schematic diagram of an endoscopic instrument partially inserted within an instrument channel of an endoscope endoscopic instrument. In various embodiments, the cap, connector, rotor and casing may be made from injection molded plastic. The spindle and the cannula may be made from surgical grade steel, and the tubing may be made from silicone. However, it should be appreciated that these materials are merely examples of materials that can be used. Those skilled in the art will appreciate that other materials may be used instead of the ones described above.
• Thetubing410 inFIG. 4A may be sized to pass through theinstrument channel120 of theendoscope100 inFIGS. 4A and 4B. Thetubing410 may include one or more pneumaticfluid entry conduits412, one or more pneumaticfluid exit conduits414, one ormore irrigation conduits416, and one ormore suction conduits418. The pneumaticfluid entry conduits412 arc configured to supply pressurized air to pneumatically drive therotor440, while the pneumaticfluid exit conduits414 remove the air supplied by the pneumaticfluid entry conduits412 to prevent a large amount of air from entering the patient's body. Theirrigation conduits416 supply an irrigation fluid, such as water, between theinner blade450 and theouter blade460 to help lubricate the area between theinner blade450 and theouter blade460. In addition, the irrigation fluid then flows from the outside of theinner blade450 to the inside portion of theinner blade450. It should be appreciated that the inside portion of theinner blade450 may be aligned with thesuction conduit418 of thetubing410 via thecap420 such that any fluid that enters theinner blade450 can pass through theinner blade450 into thesuction conduit418 of thetubing410. The irrigation fluid that flows through the inside portion of theinner blade450 and thesuction conduit418 helps lubricate thesuction conduit418, through which the debrided polyps and other waste from the patient's body are removed. As described above, thetubing410 is coupled to thecap420 at a first end, but is coupled to one or more components at a second end (not shown). For instance, at the second end, the pneumaticair entry conduits412 may be coupled to a compressed air source, while theirrigation fluid conduit416 may be coupled to a water supply source. In addition, the pneumaticfluid exit conduits414 may be coupled to the compressed air source or simply left exposed outside the patient's body for venting.
• In various embodiments, thesuction conduit418 may be coupled to a disposable cartridge that is configured to catch the cut polyps and store them for examination at a later time. In various embodiments, the disposable cartridge may include multiple collection bins. The operator may be capable of selecting the collection bin in which to collect a sample of a particular cut polyp. Upon selecting the collection bin, thesuction conduit418 supplies the collected material from within the patient's body to the particular collection bin. As such, the operator may be able to collect samples for each polyp in individual collection bins. In this way, the cancerous nature of individual polyps can be determined.
• Thecap420 may be sized to fit within the first end of thetubing410. In various embodiments, the first end of thetubing410 may include a connector that is configured to couple with thecap420. In various embodiments, thecap420 may be press fitted into the connector of thetubing410. As such, thecap420 may include corresponding conduits that match the conduits of thetubing410. Accordingly, compressed air from the compressed air source may be supplied through the pneumaticair entry conduits412 of thetubing410 and corresponding pneumatic air entry conduits of thecap420 towards therotor440. Therotor440 may include one ormore rotor blades442 on which the compressed air is impinged thereby causing therotor440 to rotate. The air impinging on therotor blades442 may then exit through the corresponding pneumatic air exit conduits of the cap and the pneumaticair entry conduits414 of thetubing410. The speed at which therotor440 can rotate depends on the amount of air and the pressure at which the air is supplied to therotor440. In various embodiments, the speed at which therotor440 rotates may be controlled by the operator of theendoscope100. Although the present disclosure discloses pneumatic means for operating the rotor, some embodiments may include hydraulic means for operating the rotor. In such embodiments, a fluid, such as water, may be supplied in lieu of compressed air, in the pneumaticair entry conduit412.
• As described above, thespindle430 is coupled to therotor440, such that when therotor440 rotates, thespindle430 also rotates. In various embodiments, the first end of thespindle430 includes theinner blade450, which correspondingly, also rotates along with therotor440. Theinner blade450 may be sized to fit within the diameter of theouter blade460. In various embodiments, irrigation fluid supplied from an irrigation fluid source may be supplied through theirrigation fluid conduit416 of thetubing410 and the corresponding conduit of thecap420, along the space between theinner blade450 and theouter blade460, and into thesuction conduit418 defined by the inner diameter of theinner blade450. It should be appreciated that since thesuction conduit418 is coupled to a vacuum source, fluids and other material may be suctioned through the suction conduit. In this way, the irrigation fluid is able to lubricate at least a substantial length of thesuction conduit418, from thetip452 of theinner blade450, through thespindle430,cap420, andtubing410 into the disposable cartridge described above.
• Theinner blade450 may rotate relative to theouter blade460 such that the interaction between theinner blade450 and theouter blade460 causes polyps to he cut upon contact with theinner blade450. In various embodiments, other mechanisms for cutting polyps may be utilized, which may or may not include the use of arotor440,inner blade450 orouter blade460.
• The debriding component may generally be configured to debride a polyp. Debriding can, for example, include any action involving detaching the polyp or a portion of the polyp from a surface of the patient's body. Accordingly, actions, including but not limited to, cutting, snaring, shredding, slicing, shattering, either entirely or partially, are also examples of debriding. Accordingly, the debriding component may be a component that is capable of cutting, snaring, shredding, slicing, shattering, a polyp from a surface of the patient's body. As such, the debriding component may be implemented as a forceps, scissor, knife, snare, shredder, or any other component that can debride a polyp. In some embodiments, the debriding component may be manually actuated such that the debriding component may be operated through the translation of mechanical forces exerted by an operator or automatically actuated, using a turbine, electrical motor, or any other force generating component to actuate the debriding component. For instance, the debriding component may be actuated hydraulically, pneumatically, or electrically. In various embodiments, a separate conduit passing through the tubing or a channel of the endoscope may be configured to carry an electrical wire to provide power to the electrically powered actuator, such as an electrical motor.
• According to various embodiments, the debriding component may include a turbine assembly, which is made up of therotor440, therotor blades442, and thespindle430. The operator may actuate the debriding component of the endoscopic instrument by supplying compressed air to the turbine assembly. When the operator is ready to begin debriding the polyp, the operator actuates the turbine assembly causing the debriding component to be actuated. In embodiments, such as the embodiment disclosed inFIG. 4, actuating the debriding component may constitute causing theinner blade450 to rotate relative to theouter blade460. Upon actuation, the operator may bring theendoscopic instrument220 towards the polyp to be debrided causing theinner blade450 to debride the polyp, causing portions of the debrided polyp to lie in the vicinity around the area where the polyp had grown. The operator may then de-actuate the turbine assembly and actuate suction through thesuction conduit418. The operator may then bring the inner blade close to the cut polyp causing the cut polyp to be retrieved through thesuction conduit418. In various embodiments, the suction component of the endoscopic instrument may be actuated while the debriding component is actuated, thereby allowing any debrided material to be retrieved by the suction component.
• Although the above embodiment houses a debriding component that utilizes a turbine assembly, the scope of the present disclosure is not limited to such embodiments. Rather, it should be appreciated by those skilled in the art that the debriding component may be manually operated or may utilize any other means of debriding a polyp such that the debrided polyps are capable of being retrieved from the surgical site via the suction conduit described above. Accordingly, examples of debriding components may include, but are not limited to, snips, blades, saws, or any other sharp tools that may or may not be driven by a turbine assembly. It should be appreciated that using a debriding component that is able to cut a polyp into small enough pieces may be desirable such that the cut pieces may be retrieved via the suction conduit without having to remove the endoscopic instrument from the endoscope.
• The geometry and assembly of the turbine assembly for rotating at least one of the cutting tool blades may be based on fluid dynamics. Bernoulli's equation can be used to explain the conversion between fluid pressure and the fluid velocity. According to this equation, the fluid velocity is related to the initial fluid pressure by the equation:
• $V=\sqrt{2*\frac{P}{D}}$
• where V is Velocity, P is Pressure, and D is Mass density.
• In order for the fluid to reach the calculated velocity, the fluid can be developed at the point of exit such that the channel through which the fluid is flowing meets an empirically determined L/D ratio of 2, where ‘D’ is the wetted diameter of the flow and the ‘L’ is the length of the channel.
• To further understand the interaction of the rotor blades and the fluid, it is assumed that the rotor blade is made so that the air jet impinges the rotor blade on a plane. The equation of linear momentum can be applied to find the forces generated:
• $\sum F=\frac{}{t}\left(\int \int \int \mathrm{Vp}*\mathrm{dVol}.\right)+\sum {\left(\stackrel{.}{m}V\right)}_{\mathrm{out}}-\sum {\left(\stackrel{.}{m}V\right)}_{\mathrm{in}}$
• where: {dot over (m)} is the mass flow of the impinging air jet, and V is Volume.
• Assuming that the control volume remains constant (volume between blades), the force created on the blade can be solved for:
• 
  ΣF={dot over (m)}(V_out−V_in)
• The quantity V_outand V_inare the same in an impulse turbine, the momentum change being created by the changing direction of the fluid only. The mass flow in is defined by the pump that is to be specified. The actual numerical value also needs to account for the velocity of the rotor. So finally, the force generated by a single blade-air jet interaction is:
• 
  ΣF={dot over (m)}(V_jet−V_rotor)−(V_jet−V_rotor)cos θ)
• 
  ΣF={dot over (m)}(V_jet−V_rotor)(1−cos θ)
• where ‘θ’ is the difference of the angle between the incoming air jet to that of the exiting air jet. Thought theoretically, the maximum amount of torque can be generated by a ‘θ’ value of 180°, but doing so will actually send the incoming jet onto the back of the following blade. Accordingly, the angle is best given a design value 15° to 20° below 180 to allow a fluid a clean exit. Finally, the force can be defined into a rotational torque:
• 
  ΣT=({dot over (m)}/r)(V_jet−V_rotor)(1−cos θ)
• A second force that can be considered comes from redirecting the air jet from the nozzle into the turbine wheel. To power the turbine, the air jet can be turned 90° into the direction of the blades from the direction of the air jet. The turning of the air jet will create a force on the stationary housing that is a function of the jet velocity, which in turn is proportional to the applied pressure:
• 
  ΣF={dot over (m)}V_jet
• This force can be reacted by the connection between the housing and the endoscope, a failure to do so can result in the ejection of the turbine assembly during operation.
• Computational analyses based on Finite Element Methods (FEM) reveal that the areas where the greatest stresses are found are located near the root of the blade where a sharp corner is located. The design of air input channel can be simplified by the existing air nozzle channel in endoscope. The air nozzle in existing endoscopes directs pressurized air across objective lens to remove moisture and also provides distension of a cavity being examined or directs pressurized water across objective lens to clear debris.
• Referring now toFIG. 4B, a perspective view diagram of the endoscopic instrument coupled to the endoscope illustrating the various conduits associated with the endoscopic instrument is shown. In particular, the pneumaticair entry conduit412 is shown supplying pressurized air to the rotor assembly, while the pneumatic air exit conduit412 (not shown in this view) removes the air from the rotor assembly to outside theendoscope100. Theirrigation channel416 is shown to carry irrigation fluid into theendoscopic instrument220, where the irrigation fluid enters into thesuction conduit418, which carries material from within the patient's body to a collection component outside the endoscope. As shown inFIG. 4B, the irrigation fluid may enter thesuction conduit418 at an irrigationfluid entry opening419. It should be appreciated that the placement of the irrigation fluid entry opening419 may be placed anywhere along the suction conduit. Due to the suction force being applied to the suction conduit, irrigation fluid may be forced into the suction conduit without the risk of the materials flowing in the suction conduit from flowing outside the suction conduit through the irrigationfluid entry opening419. Moreover, in some embodiments, the irrigation channel may only supply irrigation fluid to the endoscopic instrument while suction is being applied to the suction conduit.
• FIG. 5 illustrates a side perspective view of another endoscopic instrument coupled with the endoscope shown inFIG. 1 according to embodiments of the present disclosure. The add-onendoscopic instrument500 is sized to couple with the walls defining theinstrument channel120 of thetip104 of theendoscope100. In various embodiments, the add-onendoscopic instrument500 may be removably attached to theinstrument channel120 of theendoscope100 at thetip104 of theendoscope104 by way of an interference fit or a press fit. In other embodiments, the add-onendoscopic instrument500 may be coupled to theendoscope100 using other attachment means known to those skilled in the art.
• Referring now toFIG. 6, an enlarged view of the add-onendoscopic instrument500 is shown. The add-on endoscopic instrument includes an outer blade orsupport member510, aninner blade520 disposed within theouter blade510, arotor530 coupled to theinner blade520 and encompassed by acasing540. The casing is coupled to acap550, which is further coupled to aconnector560. In some embodiments, theconnector560 may be sized to engage with the inner diameter of theinstrument channel120 of theendoscope100. In some embodiments, any other component of the endoscopic instrument may be configured to engage with theendoscope100 in such a manner as to secure the endoscopic instrument to theinstrument channel120.
• FIGS. 7-12 illustrate perspective views of the individual components of the add-on endoscopic instrument shown inFIG. 6 according to embodiments of the present disclosure. In contrast to theendoscopic instrument220 disclosed with respect toFIGS. 1-4, the add-onendoscopic instrument500 may be adapted to fit within a first end ofinstrument channel120 of theendoscope100.
• In various embodiments, a second end of theinstrument channel120 may be coupled to a vacuum source, which causes material to be suctioned through theinstrument channel120. A suction conduit extends from the vacuum source through the instrument channel of the endoscope, and further through theconnector560, thecap550, and therotor530, to a first end of theinner blade520, which has an opening defined by the inner diameter of theinner blade520. It should be appreciated that theconnector560, thecap550, thecasing540, and therotor530 have respective center bores566,556,546 and536 that are aligned such that materials are allowed to flow from the opening of theinner blade520 to the vacuum source via the second end of theinstrument channel120.
• In addition, thecasing540 of the add-onendoscopic instrument500 includes a pneumaticair entry port542 and a pneumaticair exit port544 as shown inFIG. 10. The pneumaticair entry port542 may be adapted to receive compressed air from a compressed air source through a pneumatic air entry conduit that passes along the length of theendoscope100 to outside the patient's body, while the pneumaticair exit port544 may be adapted to vent air that is impinged on therotor530 through a pneumatic air exit conduit that passes along the length of theendoscope100 to outside the patient's body. In this way, the rotor may be actuated by supplying compressed air from the compressed air source, as described above with respect toFIGS. 1-4. It should be appreciated that although the rotor and associated components disclosed herein describe the use of pneumatic air, the rotor may he driven hydraulically. In such embodiments, the pneumatic air conduits may be configured to carry a liquid, such as water, to and from the area around the rotor.
• Referring now also toFIG. 13, it should be appreciated that the pneumatic air entry and exit conduits may extend from the add-on endoscopic instrument to a pneumatic air source through theinstrument channel120 of theendoscope100. In such embodiments, a tubing that includes separate conduits for the pneumatic air entry and exit conduits and the suction conduit may extend from outside the endoscope to the add-on endoscopic instrument within the endoscope. The tubing may be capable of being fed through the instrument channel of the endoscope and coupled to the add-onendoscopic instrument500. In such embodiments, the add-onendoscopic instrument500 may be configured with an additional component that has predefined channels that couple the respective channels of the tubing with the associated with the pneumatic air entry and exit openings of the add-on endoscopic instrument and the suction conduit formed within the add-on endoscopic instrument. In addition, an irrigation fluid channel may also be defined within the tubing such that irrigation fluid may be supplied to the add-onendoscopic instrument500, from where the irrigation fluid is diverted into the suction conduit.
• In various embodiments, the tip of theouter blade510 may be sharp and may cause discomfort to the patient while entering a cavity of the patient's body. As such, a guard structure (not shown), such as a gel cap or other similar structure, may be attached to the outer blade prior to inserting the add-on endoscopic instrument into the patient's body to prevent injuries from the outer blade contacting a surface of the patient's body. Once the endoscopic instrument is inserted in the patient's body, the guard structure may be released from theouter blade510. In various embodiments, the guard structure may dissolve upon entering the patient's body.
• Referring now toFIG. 14, an improved endoscope having a built in polyp removal assembly is shown according to embodiments of the present disclosure. Theimproved endoscope1400 may be similar to conventional endoscopes in many aspects, but may differ in that the improved endoscope may include a built inpolyp removal assembly1440 within an instrument channel of theendoscope1400. Thepolyp removal assembly1440 may include a turbine assembly having arotor1442 with rotor blades sealed in acasing1444 that has one or more inlet and outlet ports for allowing either pneumatic or hydraulic fluid to actuate therotor1442. The inlet ports may be designed such that the fluid may interact with the rotor blades at a suitable angle to ensure that the rotor can be driven at desired speeds.
• In addition, thepolyp removal assembly1440 may be coupled to aconnector1420, which is configured to couple thepolyp removal assembly1440 to atubing1470. Thetubing1470 may include a pneumaticair entry conduit1412, a pneumatic air exit conduit (not shown), anirrigation fluid conduit1416 and asuction conduit1418 that passes through the center of the turbine assembly. Thetubing1440 may be sized such that thetubing1440 can be securely coupled to theconnector1420 such that one or more of the conduits of thetubing1440 are coupled to corresponding conduits within theconnector1440. Theconnector1420 may be designed to include an irrigationfluid entry opening419, which allows irrigation fluid to pass into thesuction conduit1418 of thetubing1440 when the tubing is coupled to the connector.
• The turbine assembly of theendoscope1400 may be configured to couple with aremovable debriding assembly1460, which includes a spindle and a cannula, in a manner that causes the debriding assembly to be operational when the turbine assembly is operating.
• In other embodiments of the present disclosure, an endoscope may be designed to facilitate debriding one or more polyps and removing the debrided material associated with the polyps in a single operation. In various embodiments, the endoscope may include one or more separate channels for removing debrided material, supplying irrigation fluid, and supplying and removing at least one of pneumatic or hydraulic fluids. In addition, the endoscope may include a debriding component that may be fixedly or removably coupled to one end of the endoscope. In various embodiments, based on the operation of the debriding component, a separate debriding component channel may also be designed for the debriding component. In addition, the endoscope may include a light and a camera. In one embodiment, the endoscope may utilize existing channels to supply pneumatic or hydraulic fluids to the actuator of the endoscopic instrument for actuating the debriding component. For instance, in the endoscope shown inFIG. 1, thewater channels108A-N may be modified to supply fluids to the actuator pneumatically or hydraulically. In such embodiments, the endoscopic instrument may include a connector having a first end capable of being coupled to an opening associated with existing channels108 of the endoscope, while another end of the connector is exposed to an opening at the actuator.
• In various embodiments of the present disclosure, the endoscopic instrument may further be configured to detect the presence of certain layers of tissue. This may be useful for physicians to take extra precautions to prevent bowel perforations while debriding polyps. In some embodiments, the endoscopic instrument may be equipped with a sensor that can communicate with a sensor processing component outside the endoscope to determine the type of tissue. The sensor may gather temperature information as well as density information and provide signals corresponding to such information to the sensor processing unit, which can identify the type of tissue being sensed. In some implementations, the sensor may be an electrical sensor.
• In addition, the endoscopic instrument may be equipped with an injectable dye component through which a physician may mark a particular region within the patient's body. In other embodiments, the physician may mark a particular region utilizing the debriding component, without the use of an injectable dye.
• Although the present disclosure discloses various embodiments of an endoscopic instrument, including but not limited to a tool that may be attached to the tip of the endoscope, and a tool that may be fed through the length of the endoscope, the scope of the present disclosure is not intended to be limited to such embodiments or to endoscopic instruments in general. Rather, the scope of the present disclosure extends to any device that may debride and remove polyps from within a patient's body using a single tool. As such, the scope of the present disclosure extends to improved endoscopes that may be built with some or all of the components of the endoscopic instruments described herein. For instance, an improved endoscope with an integrated turbine assembly and configured to be coupled to a debriding component is also disclosed herein. Furthermore, the endoscope may also include predefined conduits that extend through the length of the endoscope such that only the suction conduit may be defined by a disposable tubing, while the air entry and exit conduits and the irrigation conduit are permanently defined within the improved endoscope. In other embodiments, the suction conduit is also predefined but made such that the suction conduit may be cleaned and purified for use with multiple patients. Similarly, the debriding component may also be a part of the endoscope, but also capable of being cleaned and purified for use with multiple patients. Furthermore, it should be understood by those skilled in the art that any or all of the components that constitute the endoscopic instrument may be built into an existing endoscope or into a newly designed endoscope for use in debriding and removing polyps from within the patient's body.
• Referring now toFIG. 15, a conceptual system architecture diagram illustrating various components for operating the endoscopic instrument according to embodiments of the present disclosure is shown. Theendoscopic system1500 includes anendoscope100 fitted with anendoscopic instrument220, and which may be coupled to an airsupply measurement system1510, anirrigation system1530 and apolyp removal system1540. As described above, the tubing that extends within theendoscope100 may include one or more pneumaticair entry conduits412 and one or more pneumaticair exit conduits414. The pneumaticair entry conduits412 are coupled to the airsupply measurement system1510, which includes one or more sensors, gauges, valves, and other components to control the amount of gas, such as air, being supplied to theendoscope100 to drive therotor440. In some embodiments, the amount of air being supplied to therotor440 may be controlled using the airsupply measurement system1510. Furthermore, delivery of the air to actuate therotor440 may be manually controlled by the physician using theendoscope100. In one embodiment, the physician may use a foot pedal or a hand-actuated lever to supply air to therotor440.
• The pneumaticair exit conduit414, however, may not be coupled to any component. As a result, air exiting from therotor440 may simply exit the endoscope via the pneumaticair exit conduit414 into the atmosphere. In some embodiments, the pneumaticair exit conduit414 may be coupled to the airsupply measurement system1510 such that the air exiting the pneumaticair exit conduit414 is supplied back to the rotor via the pneumaticair entry conduit412. It should be appreciated that a similar setup may be used for a hydraulically driven turbine system.
• Theendoscope100 may also be coupled to theirrigation system1530 via theirrigation fluid conduit416. Theirrigation system1530 may include aflow meter1534 coupled to anirrigation source1532 for controlling the amount of fluid flowing from theirrigation source1532 to theendoscope100.
• As described above, theendoscope100 may also include asuction conduit418 for removing polyps from within the patient's body. Thesuction conduit418 may be coupled to thepolyp removal system1540, which may be configured to store the polyps. In various embodiments, the physician may be able to collect samples in one ormore cartridges1542 within thepolyp removal system1540 such that the removed polyps can be tested individually.
• In various embodiments of the present disclosure, an endoscope, comprises a first end and a second end separated by a flexible housing, an instrument channel extending from the first end to the second end, and an endoscopic instrument comprising a debriding component and a sample retrieval conduit disposed within the instrument channel. The endoscopic instrument may further include a flexible tubing in which the sample retrieval conduit is partially disposed, the flexible tubing extending from the first end to the second end of the endoscope. The flexible tubing may also include a pneumatic air entry conduit and a fluid irrigation conduit. In various embodiments, the debriding component may include a turbine assembly and a cutting tool. In various embodiments in which the endoscope is configured to have a built in endoscopic instrument, the instrument channel may have a diameter that is larger than the instrument channels of existing endoscopes. In this way, larger portions of debrided material may be suctioned from within the patient's body without clogging the suction conduit.
• In other embodiments, an endoscope may include a first end and a second end separated by a flexible housing; an instrument channel extending from the first end to the second end; and an endoscopic instrument coupled to the instrument channel at the first end of the endoscope, the endoscopic instrument comprising a debriding component and a sample retrieval conduit partially disposed within the instrument channel. In some embodiments, the endoscopic instrument may be removably attached to the endoscopic instrument.
• In other embodiments of the present disclosure, an endoscopic system, includes an endoscope comprising a first end and a second end separated by a flexible housing and an instrument channel extending from the first end to the second end and an endoscopic instrument coupled to the instrument channel at the first end of the endoscope. The endoscopic instrument may include a debriding component and a flexible tubing having a length that is greater than the length of the endoscope. Moreover, the flexible tubing may include a sample retrieval conduit, an pneumatic air entry conduit, and a fluid irrigation conduit, a disposable cartridge configured to couple with the sample retrieval conduit proximal the second end of the endoscope, a pressurized air source configured to couple with the pneumatic air entry conduit proximal the second end of the endoscope, and a fluid irrigation source configured to couple with the fluid irrigation conduit proximal the second end of the endoscope. In various embodiments, the endoscope may also include at least one camera source and at least one light source. In some embodiments of the present disclosure, the pneumatic air entry conduit supplies pressurized air to a turbine assembly of the debriding component proximal the first end of the endoscope and the fluid irrigation conduit supplies irrigation fluid to the sample retrieval conduit proximal the first end of the endoscope.
• FIG. 16A illustrates an exploded partial view of anendoscopic instrument1600, which is similar to theendoscopic instrument150 depicted inFIG. 1C in that theendoscopic instrument1600 is configured to be inserted within an instrument channel of an endoscope, such as theendoscope100 depicted inFIG. 1B.FIG. 16B illustrates a cross-sectional partial view of the endoscopic instrument shown inFIG. 16A. As shown inFIGS. 16A and 16B, a head portion of theendoscopic instrument1600 can include apowered actuator1605, a power-driveninstrument head1680 including acutting shaft1610 and anouter structure1615 and afeedthrough connector1620 coupled to a distal end of aflexible tubular member1630. Theflexible tubular member1630 forms the tail portion of theendoscopic instrument1600. As such,FIGS. 16A and 16B illustrate the head portion of theendoscopic instrument1600.
• Theendoscopic instrument1600 is configured to define anaspiration channel1660 that extends from a proximal end of theflexible tubular member1630 to adistal tip1614 of the power-driveninstrument head1680. In some implementations, the proximal end of theflexible tubular member1630 may be configured to fluidly couple to a vacuum source. In this way, upon the application of a suction force at the proximal end of theflexible tubular member1630, material at or around thedistal tip1614 of the power-driveninstrument head1680 can enter theendoscopic instrument1600 at the distal tip and flow through theaspiration channel1660 all the way to the proximal end of theflexible tubular member1630.
• Thepowered actuator1605 can be configured to drive a power-driveninstrument head1680, which includes the cuttingshaft1610 disposed within theouter structure1615. In some implementations, thepowered actuator1605 can include adrive shaft1608 that is mechanically coupled to thecutting shaft1610. In some implementations, one or more coupling elements may be used to couple thedrive shaft1608 to aproximal end1611 of the cuttingshaft1610 such that the cuttingshaft1610 is driven by thedrive shaft1608. Thepowered actuator1605 can be an electrically powered actuator. In some implementations, the electrically powered actuator can include an electrical terminal1606 configured to receive an electrical conducting wire for providing electrical current to the electricallypowered actuator1605. In some implementations, the electrically powered actuator can include an electric motor. In some implementations, the electric motor can be a micro-sized motor, such that the motor has an outer diameter of less than a few millimeters. In some implementations, thepowered actuator1605 has an outer diameter that is smaller than about 3.8 mm. In addition to having a small footprint, thepowered actuator1605 may be configured to meet certain torque and rotation speed parameters. In some implementations, thepowered actuator1605 can be configured to generate enough torque and/or rotate at sufficient speeds to be able to cut tissue from within a subject. Examples of motors that meet these requirements include micromotors made by Maxon Precision Motors, Inc., located in Fall River, Mass., USA. Other examples of electrical motors include any type of electric motors, including AC motors, DC motors, piezoelectric motors, amongst others.
• The power-driveninstrument head1680 is configured to couple to thepowered actuator1605 such that thepowered actuator1605 can drive the power-driven instrument head. As described above, theproximal end1611 of the cuttingshaft1610 can be configured to couple to thedrive shaft1608 of thepowered actuator1605. Thedistal end1614 of the cuttingshaft1610 opposite theproximal end1611 can include acutting tip1612. Thecutting tip1612 can include one or more sharp surfaces capable of cutting tissue. In some implementations, the cuttingshaft1610 can be hollow and can define amaterial entry port1613 at or around thecutting tip1612 through which material that is cut can enter theendoscopic instrument1610 via thematerial entry port1613. In some implementations, theproximal end1611 of the cuttingshaft1610 can include one ormore outlet holes1614 that are sized to allow material flowing from thematerial entry port1613 to exit from the cuttingshaft1610. As shown inFIGS. 16A and 16B, the outlet holes1614 are defined within the walls of the cuttingshaft1610. In some implementations, theseoutlet holes1614 can be sized such that material entering the cuttingshaft1610 via thematerial entry port1613 can flow out of the cuttingshaft1610 via the outlet holes1614. In some implementations, the portion of the cuttingshaft1610 proximal thedrive shaft1608 may be solid such that all the material that enters the cuttingshaft1610 flows out of the cuttingshaft1610 via the outlet holes1614.
• Theouter structure1615 can be hollow and configured such that the cutting shaft can be disposed within theouter structure1615. As such, theouter structure1615 has an inner diameter that is larger than the outer diameter of the cuttingshaft1610. In some implementations, theouter structure1615 is sized such that the cuttingshaft1610 can rotate freely within theouter structure1615 without touching the inner walls of theouter structure1615. Theouter structure1615 can include anopening1616 at adistal end1617 of theouter structure1615 such that when the cuttingshaft1610 is disposed within theouter structure1615, thecutting tip1612 and thematerial entry port1613 defined in thecutting shaft1610 is exposed. In some implementations, the outer surface of the cuttingshaft1610 and the inner surface of theouter structure1615 can be coated with a heat-resistant coating to help reduce the generation of heat when the cuttingshaft1610 is rotating within theouter structure1615. A proximal end of theouter structure1615 is configured to attach to the housing that houses thepowered actuator1605.
• Thefeedthrough connector1620 can be positioned concentrically around the portion of the cuttingshaft1610 that defines the outlet holes1614. In some implementations, thefeedthrough connector1620 can be hollow and configured to enclose the area around the outlet holes1614 of the cuttingshaft1610 such that material leaving the outlet holes1614 of the cuttingshaft1610 is contained within thefeedthrough connector1620. Thefeedthrough connector1620 can include anexit port1622, which can be configured to receive the distal end of thetubular member1630. In this way, any material within thefeedthrough connector1620 can flow into the distal end of theflexible tubular member1630. Thefeedthrough connector1620 can serve as a fluid coupler that allows fluid communication between the cuttingshaft1610 and thetubular member1630.
• Thetubular member1630 can be configured to couple to theexit port1622 of thefeedthrough connector1620. By way of the cuttingshaft160, thefeedthrough connector1620 and theflexible tubular member1630, theaspiration channel1660 extends from thematerial entry port1613 of the cuttingshaft1610 to the proximal end of thetubular member1630. In some implementations, thetubular member1630 can be configured to couple to a vacuum source at the proximal end of thetubular member1630. As such, when a vacuum source applies suction at the proximal end of thetubular member1630, material can enter the aspiration channel via thematerial entry port1613 of the cuttingshaft1610 and flow through theaspiration channel1660 towards the vacuum source and out of theendoscopic instrument1600. In this way, theaspiration channel1660 extends from one end of the endoscopic instrument to the other end of theendoscopic instrument1600. In some implementations, a vacuum source can be applied to thetubular member1630 such that the material at the treatment site can be suctioned from the treatment site, through theaspiration channel1660 and withdrawn from theendoscopic instrument1600, while theendoscopic instrument1600 remains disposed within the instrument channel of the endoscope and inside the subject being treated. In some implementations, one or more of the surfaces of the cuttingshaft1610, thefeedthrough connector1620 or thetubular member1630 can be treated to improve the flow of fluid. For example, the inner surfaces of the cuttingshaft1610, thefeedthrough connector1620 or thetubular member1630 may be coated with a superhydrophobic material to reduce the risk of material removed from within the patient from clogging the suction conduit.
• Examples of various types of instrument heads that can be coupled to thepowered actuator1605 are disclosed in U.S. Pat. No. 4,368,734, U.S. Pat. No. 3,618,611, U.S. Pat. No. 5,217,479, U.S. Pat. No. 5,931,848 and U.S. Pat. Publication 2011/0087260, amongst others. In some other implementations, the instrument head can include any type of cutting tip that is capable of being driven by a powered actuator, such as thepowered actuator1650, and capable of cutting tissue into small enough pieces such that the tissue can be removed from the treatment site via the aspiration channel defined within theendoscopic instrument1600. In some implementations, the power-driveninstrument head1680 may be configured to include a portion through which material from the treatment site can be removed. In some implementations, the circumference of the aspiration channel can be in the order of a few micrometers to a few millimeters.
• In some implementations, where thepowered actuator1620 utilizes an electric current for operation, the current can be supplied via one or more conductive wires that electrically couple the powered actuator to an electrical current source. In some implementations, the electrical current source can be external to theendoscopic instrument1600. In some implementations, theendoscopic instrument1600 can include an energy storage component, such as a battery that is configured to supply electrical energy to the electrical actuator. In some implementations, the energy storage component can be positioned within the endoscopic instrument. In some implementations, the energy storage component or other power source may be configured to supply sufficient current to the powered actuator that cause the powered actuator to generate the desired amount of torque and/or speed to enable thecutting shaft1610 to cut tissue material. In some implementations, the amount of torque that may be sufficient to cut tissue can be greater than or equal to about 2.5 N mm. In some implementations, the speed of rotation of the cutting shaft can be between 1000 and 5000 rpm. However, these torque ranges and speed ranges are examples and are not intended to be limiting in any manner.
• Theendoscopic instrument1600 can include other components or elements, such asseals1640 andbearings1625, which are shown. In some implementations, theendoscopic instrument1600 can include other components that are not shown herein but may be included in theendoscopic instrument1600. Examples of such components can include sensors, cables, wires, as well as other components, for example, components for engaging with the inner wall of the instrument channel of an endoscope within which the endoscopic instrument can be inserted. In addition, the endoscopic instrument can include a housing that encases one or more of the powered actuator, thefeedthrough connector1620, any other components of theendoscopic instrument1600. In some implementations, the tail portion of theendoscopic instrument1600 can also include a flexible housing, similar to theflexible portion165 shown inFIG. 1C, that can carry one or more flexible tubular members, such as theflexible tubular member1630, as well as any other wires, cables or other components.
• In some implementations, the endoscopic instrument can be configured to engage with the instrument channel of an endoscope in which the instrument is inserted. In some implementations, an outer surface of the head portion of the endoscopic instrument can engage with an inner wall of the instrument channel of the endoscope such that the endoscopic instrument does not experience any unnecessary or undesirable movements that may occur if endoscopic instrument is not supported by the instrument channel. In some implementations, the head portion of the body of the endoscopic instrument can include a securing mechanism that secures the head portion of the body to the inner wall of the instrument channel. In some implementations, the securing mechanism can include deploying a frictional element that engages with the inner wall. The frictional element can be a seal, an o-ring, a clip, amongst others.
• FIG. 16C illustrates a schematic view of an engagement assembly of an example endoscopic instrument.FIG. 16D shows a cut-open view of the engagement assembly when the engagement assembly is disengaged.FIG. 16E shows a cut-open view of the engagement assembly when the engagement assembly is configured to engage with an instrument channel of an endoscope. As shown inFIGS. 16C and 16D, theengagement assembly1650 includes ahousing portion1652 that defines acylindrical groove1654 around anouter surface1656 of the housing portion. Thegroove1654 is sized such that acompliant seal component1670 can be partially seated within thegroove1654. Acylindrical actuation member1660 is configured to encompass thehousing portion1652. Thecylindrical actuation member1660 can slidably move along the length of thehousing portion1652. Thecylindrical actuation member1660 is configured to engage the securingmember1670 by pressing on the surface of the securingmember1670. Theactuation member1660 can apply a force on the securingmember1670 causing the securingmember1670 to deform such that the securingmember1670 becomes flatter and wider. The securingmember1670 is configured such that when the securingmember1670 widens, the outer surface of the securingmember1670 can engage with an inner surface of the instrument channel of an endoscope in which the endoscopic instrument is inserted. In this way, when thecylindrical actuation member1660 is actuated, theendoscopic instrument1600 can engage with the instrument channel thereby preventing theendoscopic instrument1600 from moving relative to the instrument channel. This can help provide stability to the operator while treating the subject. In some implementations, more than oneengagement assembly1650 can be positioned along various portions of theendoscopic instrument1600.
• FIG. 17A illustrates an exploded view of an exampleendoscopic instrument1700 according to embodiments of the present disclosure.FIG. 17B illustrates a cross-sectional view of theendoscopic instrument1700. Theendoscopic instrument1700, similar to theendoscopic instrument1600 shown inFIGS. 16A and 16B, can also be configured to be inserted within an instrument channel of an endoscope, such as theendoscope100 depicted inFIG. 1B. Theendoscopic instrument1700, however, differs from theendoscopic instrument1600 in that theendoscopic instrument1700 defines anaspiration channel1760 that extends through apowered actuator1705. In this way, material entering amaterial entry port1713 of theendoscopic instrument1700 can flow through theendoscopic instrument1700 and out of the endoscopic instrument in a straight line.
• As shown inFIGS. 17A and 17B, theendoscopic instrument1700 is similar to theendoscopic instrument1600 except that the endoscopic instrument includes a differentpowered actuator1705, adifferent cutting shaft1710 and adifferent feedthrough connector1720. Thepowered actuator1705 is similar to thepowered actuator1605 shown inFIG. 16A but differs in that thepowered actuator1705 includes adrive shaft1708 that is hollow and extends through the length of thepowered actuator1705. Since some of the components are different, the manner in which the endoscopic instrument is assembled is also different.
• In some implementations, thepowered actuator1605 can be any actuator capable of having a hollow shaft that extends through the length of the motor. Thedistal end1708aof thedrive shaft1708 includes a first opening and is coupled to the proximal end1711 of the cuttingshaft1705. Unlike the cuttingshaft1610, the cuttingshaft1710 includes afluid outlet hole1714 at the bottom of the cuttingshaft1710. As a result, the entire length of the cuttingshaft1710 is hollow. Theproximal end1708bof thedrive shaft1708 is configured to couple to thefeedthrough connector1720, which differs from thefeedthrough connector1620 in that thefeedthrough connector1720 includes ahollow bore1722 defining a channel in line with the proximal end of the drive shaft such that thedrive shaft1708 and thehollow bore1722 are fluidly coupled. Thehollow bore1722 can be configured to couple to theflexible tubular member1730, which like theflexible tubular member1630, extends from the feedthrough connector at a distal end to a proximal end that is configured to couple to a vacuum source.
• As shown inFIGS. 17A and 17B, thedrive shaft1708 can be hollow, such that thedrive shaft1708 defines a first opening at adistal end1708aand a second opening at aproximal end1708bof thedrive shaft1708. The cuttingshaft1710 is also hollow and defines anopening1714 at thebottom end1710aof the cuttingshaft1710. Thedistal end1708aof thedrive shaft1708 is configured to couple to thebottom end1710aof the cuttingshaft1710 such that the first opening of thedrive shaft1708 is aligned with the opening at thebottom end1710aof the cuttingshaft1710. In this way, thedrive shaft1708 can be fluidly coupled to thecutting shaft1710. Adistal end1710bof the cuttingshaft1710 includes acutting tip1712 and thematerial entry port1713.
• Theproximal end1708aof thedrive shaft1708 is fluidly coupled to a distal end of theflexible tubular member1730 via thefeedthrough connector1720. In some implementations, thefeedthrough connector1720 couples the drive shaft and the flexible tubular member such that the flexible tubular member does not rotate with the drive shaft. The proximal end of the flexible tubular member can be configured to couple to a vacuum source.
• As shown inFIG. 17B, theendoscopic instrument1700 defines anaspiration channel1760 that extends from thematerial entry port1713 through the cutting shaft, the drive shaft, thefeedthrough connector1720 to the second end of theflexible tubular member1730. In this way, material that enters thematerial entry port1713 can flow through the length of the endoscopic instrument and exit from the endoscopic instrument at the second end of the endoscopic instrument.
• Other components of theendoscopic instrument1700 are similar to those shown in theendoscopic instrument1600 depicted inFIGS. 16A and 16B. For example, theouter structure1715, theencoding component1606, the seals and the bearings may be substantially similar to theouter structure1615, theencoding component1606, theseals1640 and thebearings1625 depicted inFIG. 16. Other components, some of which are shown, may be included to construct the endoscopic instrument and for proper functioning of the instrument.
• FIG. 18A illustrates an exploded view of an exampleendoscopic instrument1800 according to embodiments of the present disclosure.FIG. 18B illustrates a cross-sectional view of theendoscopic instrument1800. Theendoscopic instrument1800, similar to theendoscopic instrument1700 shown inFIGS. 17A and 17B, can also be configured to be inserted within an instrument channel of an endoscope, such as theendoscope100 depicted inFIG. 1B. Theendoscopic instrument1800, however, differs from theendoscopic instrument1700 in that theendoscopic instrument1800 includes a pneumatic or hydraulically poweredactuator1805.
• In some implementations, thepowered actuator1802 includes a tesla turbine that includes atesla rotor1805, ahousing1806 and aconnector1830 that along with thehousing1806 encases thetesla rotor1805. Thetesla rotor1805 can include a plurality ofdisks1807 spaced apart and sized such that thetesla rotor1805 fits within the housing. In some implementations, the tesla rotor can include between 7 and 13 disks having a diameter between about 2.5 mm and 3.5 mm and thicknesses between 0.5 mm to 1.5 mm. In some implementations, the disks are separated by gaps that range from 0.2 mm to 1 mm. Thetesla turbine1802 also can include ahollow drive shaft1808 that extends along a center of thetesla rotor1805. In some implementations, adistal end1808aof thedrive shaft1808 is configured to be coupled to acutting shaft1810 such that the cuttingshaft1810 is driven by the tesla rotor. That is, in some implementations, the cuttingshaft1810 rotates as thedrive shaft1808 of thetesla rotor1805 is rotating. In some implementations, the cuttingshaft1810 can include outlet holes similar to thecutting shaft1610 shown inFIG. 16A. In some such implementations, the feedthrough connector fluidly couples the cutting shaft and the flexible portion similar to thefeedthrough connector1630 shown inFIG. 16A.
• Theconnector1830 of thetesla turbine1802 can include at least onefluid inlet port1832 and at least onefluid outlet port1834. In some implementations, thefluid inlet port1832 and thefluid outlet port1834 are configured such that fluid can enter thetesla turbine1802 via thefluid inlet port1832, cause thetesla rotor1805 to rotate, and exit thetesla turbine1802 via thefluid outlet port1834. In some implementations, thefluid inlet port1832 is fluidly coupled to a fluidinlet tubular member1842 configured to supply fluid to the tesla rotor via thefluid inlet port1832. Thefluid outlet port1834 is fluidly coupled to a fluidoutlet tubular member1844 and configured to remove the fluid supplied to thetesla turbine1802. The amount of fluid being supplied and removed from thetesla turbine1802 can be configured such that thetesla rotor1805 can generate sufficient torque, while rotating at a sufficient speed to cause thecutting shaft1810 to cut tissue at a treatment site. In some implementations, the fluid can be air or any other suitable gas. In some other implementations, the fluid can be any suitable liquid, such as water. Additional details related to how fluid can be supplied or removed from pneumatic or hydraulic actuators, such as thetesla turbine1802 has been described above with respect toFIGS. 4A-15.
• Theconnector1830 also includes asuction port1836 that is configured to couple to an opening defined at aproximal end1808bof thehollow drive shaft1808. Thesuction port1836 is further configured to couple to a distal end of aflexible tubular member1846, similar to theflexible tubular member1730 shown inFIG. 17A, which is configured to couple to a vacuum source at a proximal end. In some implementations, a flexible tubular housing can include one or more of the fluid inlet tubular member184, fluidoutlet tubular member1844 and theflexible tubular member1846. In some implementations, the flexible tubular housing can include other tubular members and components that extend from the head portion of the endoscopic instrument to the proximal end of the tail portion of theendoscopic instrument1800.
• The cuttingshaft1810 and anouter structure1815 are similar to thecutting shaft1710 and theouter structure1715 of theendoscopic instrument1700 depicted inFIG. 17A. The cuttingshaft1810 is hollow and defines an opening at a proximal end1810bof the cuttingshaft1810. The proximal end1810bof the cuttingshaft1810 is configured to couple to adistal end1808aof thedrive shaft1808 such that an opening at thedistal end1808aof thedrive shaft1808 is aligned with the opening defined at theproximal end1808bof the cuttingshaft1810. In this way, thedrive shaft1808 can be fluidly coupled to thecutting shaft1810. A distal end1810bof the cuttingshaft1810 includes acutting tip1812 and amaterial entry port1813 similar to thecutting shafts1610 and1710 shown inFIGS. 16A and 17A.
• In some implementations, anirrigation opening1852 can be formed in thehousing1806. Theirrigation opening1852 is configured to be fluidly coupled to the aspiration channel1860. In some such implementations, theirrigation opening1852 is configured to be fluidly coupled to a gap (not clearly visible) that separates the walls ofouter structure1815 and the cuttingshaft1810. In this way, fluid supplied to thetesla turbine1802 can escape via theirrigation opening1852 in to the gap. The fluid can flow towards thematerial entry port1813 of the cuttingshaft1810, through which the fluid can enter the aspiration channel1860. In some implementations, since the aspiration channel1860 is fluidly coupled to a vacuum source, the fluid from thetesla turbine1802 can be directed to flow through the aspiration channel1860 as irrigation fluid along with any other material near thematerial entry port1813. In this way, the irrigation fluid can irrigate the aspiration channel1860 to reduce the risk of blockages.
• In addition, as the irrigation fluid flows in the gap separating theouter structure1815 and the cuttingshaft1810, the irrigation fluid can serve to reduce the generation of heat. In some implementations, one or both of the cuttingshaft1810 and theouter structure1815 can be coated with a heat-resistant layer to prevent the cutting shaft and the outer structure from getting hot. In some implementations, one or both of the cuttingshaft1810 and theouter structure1815 can be surrounded by a heat-resistant sleeve to prevent thecutting shaft1810 and theouter structure1815 from getting hot.
• In some implementations, other types of hydraulically or pneumatically powered actuators can be utilized in place of the tesla turbine. In some implementations, a multi-vane rotor can be used. In some such implementations, the powered actuator can be configured to be fluidly coupled to a fluid inlet tubular member and a fluid outlet tubular member similar to thetubular members1842 and1844 shown inFIG. 18B.
• As described above with respect to theendoscopic instruments1600,1700 and1800 depicted inFIGS. 16A,17A and18A, an endoscopic instrument is configured to meet certain size requirements. In particular, the endoscopic instrument can be long enough such that when the endoscopic instrument is completely inserted into the endoscope, the power-driven instrument head can extend beyond the face of the endoscope at one end such that the cutting tip is exposed, while the tail portion of the endoscopic instrument can extend out of the other end of the endoscope such that the tail portion can be coupled to a vacuum source. As such, in some implementations, the endoscopic instrument may be configured to be longer than the endoscopes in to which the endoscopic instrument will be inserted. Further, since endoscopes have instrument channels that have different diameters, the endoscopic instrument may also be configured to have an outer diameter that is sufficiently small such that the endoscopic instrument can be inserted into the instrument channel of the endoscope in to which the endoscopic instrument will be inserted.
• Some endoscopes, such as colonoscopes, can have instrument channels that have an inner diameter that can be as small as a few millimeters. In some implementations, the outer diameter of the endoscopic instrument can be less than about 3.2 mm. As such, powered actuators that are part of the endoscopic instrument may be configured to have an outer diameter than is less than the outer diameter of the endoscopic instrument. At the same time, the powered actuators may be configured to be able to generate sufficient amounts of torque, while rotating at speeds sufficient to cut tissue at a treatment site within a subject.
• In some other implementations, the endoscopic instrument can be configured such that a powered actuator is not housed within the endoscopic instrument at all or at least within a portion of the endoscopic instrument that can be inserted within the instrument channel of an endoscope. Rather, the endoscopic instrument includes a flexible cable that is configured to couple a power-driven instrument head of the endoscopic instrument to a powered actuator that is located outside of the endoscope.
• FIG. 19A illustrates an exampleendoscopic instrument1900 that is coupled to a powered actuation and vacuum system1980. The endoscopic instrument includes ahead portion1902 and a tail portion. The tail portion includes theflexible cable1920, which can provide torque to thehead portion1902. The powered actuation and vacuum system1980 includes apowered actuator1925, acoupler1935 and avacuum tubing1930 configured to couple to thecouple1935 at afirst end1932 and couple to a vacuum source at asecond end1934. In some implementations, theflexible cable1920 can be hollow and configured to carry fluid from thehead portion1902 to thecoupler1935.
• FIG. 19B illustrates a cross-section view of the powered actuation and vacuum system1980 ofFIG. 19A. Thepowered actuator1925 includes adrive shaft1926 that is mechanically coupled to aproximal end1922 of theflexible cable1920. In some implementations, thedrive shaft1926 and theflexible cable1920 are mechanically coupled via thecoupler1935. Thecoupler1935 includes avacuum port1936 to which afirst end1932 of thevacuum tubing1930 can be fluidly coupled. Thecoupler1935 can be enclosed such that thevacuum tubing1930 and the flexible cable are fluidly coupled. In this way, suction applied in thevacuum tubing1930 can be applied all the way through theflexible cable1920 to thehead portion1902 of theendoscopic instrument1900. Further, any material that is in theflexible cable1920 can flow through the flexible cable to thevacuum tubing1930 via thecoupler1935. In some implementations, the coupling between the flexible cable and the vacuum tubing can occur within thehead portion1902. In such implementations, thecoupler1935 may be configured to be small enough to be positioned within thehead portion1902.
• FIG. 19C illustrates an exploded view of an example head portion of theendoscopic instrument1900 shown inFIG. 19A. The head portion includes ahousing cap1952, acollet1954, a cuttingshaft1956, ashaft coupler1958 and ahead portion housing1960. In some implementations, thecollet1954 is slightly tapered towards a distal end such that thecollet1954 can couple with the cuttingshaft1956 that is disposed within thecollet1954. Theshaft coupler1958 is configured to couple the cutting shaft to the distal end of theflexible cable1920. Thehead portion1960 and thehousing cap1952 are configured to house theshaft coupler1958.
• FIG. 19D illustrates a cut-open view of a portion of theendoscopic instrument1900 having an engagement assembly. In some implementations, thehead portion housing1960 can include an engagement assembly for engaging with the inner walls of an instrument channel. The engagement assembly can be similar to theengagement assembly1650 shown inFIG. 16C. In some implementations, the engagement assembly can be actuated via a vacuum source.FIG. 19E shows a cut-open view of the engagement assembly shown inFIG. 19D in a disengaged position.FIG. 19F shows a cut-open view of the engagement assembly shown inFIG. 19D in an engaged position.
• The engagement assembly can include a pair of vacuum actuatedmembers1962 that are configured to rotate between an extended position in which themembers1962 are extended outwardly to engage with a wall of the instrument channel1990 and a retracted position in which themembers1962 are positioned such that they lie substantially parallel to the walls of the instrument channel1990. The grooves1964 are fluidly coupled to an aspiration channel1970 defined within theflexible cable1920. In some implementations,fluid channels1966 fluidly couple the grooves1964 to the aspiration channel1970. When a vacuum source is applied to the aspiration channel1970, a suction force is applied to themembers1962 causing them to move from a retracted position (as shown inFIG. 19E) to an extended position (as shown inFIG. 19F). In some implementations, the engagement assembly can also include an outer ring supported by the vacuum actuated members1964. Theouter ring1966 can be configured to assist in guiding the endoscopic instrument through the instrument channel of the endoscope. In particular, the outer ring can prevent the endoscopic instrument from tilting to one side causing the power-driven instrument head from jarring against the instrument channel.
• Theendoscopic instrument1900 is similar to theendoscopic instruments1600,1700 and1800 depicted inFIGS. 16A-18A respectively but differs from them in that theendoscopic instrument1900 does not include a powered actuator within thehead portion1902 of theendoscopic instrument1900. Instead, theendoscopic instrument1900 includes aflexible cable1920 for providing torque to a power-driveninstrument head1904 of theendoscopic instrument1900. In some implementations, the power-driveninstrument head1904 can be similar to the power-driven instrument heads depicted inFIGS. 16A-18A. In some implementations, theflexible cable1920 can be hollow such that fluid can flow through theflexible cable1920. In some such implementations, aproximal end1922 of theflexible cable1920 can be configured to couple to a vacuum source, while adistal end1921 of theflexible cable1920 can be coupled to the power-driveninstrument head1904. In this way, fluid that enters amaterial entry port1907 can flow through the power-driveninstrument head1904 and into theflexible cable1920, from which the fluid can flow through theflexible cable1920 and be removed from theendoscopic instrument1900 at theproximal end1922 of theflexible cable1920.
• In some implementations, a flexible cable, such as theflexible cable1920 can replace a powered actuator and drive shaft that are housed within an endoscopic instrument. For example, theendoscopic instruments1600,1700 and1800 depicted inFIGS. 16A,17A and18A can be configured to utilize a flexible cable that is coupled to a cutting shaft of a power-driven instrument head at a distal end and coupled to a powered actuator located outside the endoscopic instrument at a proximal end. The powered actuator located outside the endoscopic instrument may be significantly larger than thepowered actuators1605,1705 or1805. As the powered actuator is actuated, torque generated by the powered actuator can be translated from the powered actuator to the power-driven instrument head via the flexible cable. Theflexible cable1920 is configured to translate torque from the powered actuator to the cutting shaft. In some implementations, theflexible cable1920 is or includes a fine coil with multiple threads and multiple layers, which can transmit the rotation of one end of the flexible cable to an opposite end of the flexible cable. The flexibility of the cable allows the coil to maintain performance even in sections of the coil that are bent. Examples of theflexible cable1920 include torque coils made by ASAHI INTECC USA, INC located in Santa Ana, Calif., USA. In some implementations, theflexible cable1920 can be surrounded by a sheath to avoid frictional contact between the outer surface of the flexible cable and other surfaces. In some implementations, theflexible cable1920 can be coated with Polytetrafluoroethylene (PFTE) to reduce frictional contact between the outer surface of the flexible cable and other surfaces.
• FIG. 20 is a conceptual system architecture diagram illustrating various components for operating the endoscopic instrument according to embodiments of the present disclosure. Theendoscopic system2000 includes anendoscope100 fitted with anendoscopic instrument2002 that includes aflexible tail portion2004. The endoscopic instrument can, for example, be theendoscopic instrument220,1600,1700,1800 or1900 shown inFIGS. 4A-14,16A,17A,18A and19A. The system also includes anendoscope control unit2005 that controls the operation of theendoscope100 and aninstrument control unit2010 that controls the operation of theendoscopic instrument2002.
• In addition, the endoscopic instrument also includes a vacuum source1990, asample collection unit2030 and atissue sensing module2040. The vacuum source1990 is configured to fluidly couple to a flexible tubular member that forms a portion of the aspiration channel. In this way, material that flows from the endoscopic instrument through the aspiration channel towards the vacuum source1990 can get collected at2030 sample collection unit. The tissue sensing module can be communicatively coupled to a tissue sensor disposed at a distal tip of theendoscopic instrument2000. In some such implementations, the tissue sensing module can also be configured to be communicatively coupled to theinstrument control unit2010 such that the tissue sensing module can send one or more signals instructing thecontrol unit2010 to stop the actuation of the powered actuator.
• In some implementations in which the powered actuator is electrically actuated and disposed within the endoscopic instrument, the powered actuator can be electrically coupled to theinstrument control unit2010. In some such implementations, the powered actuator is coupled to the control unit via one or more electric cables. In some implementations, the powered actuator may be battery operated in which case, the tubing may include cables extending from the control unit to the powered actuator or the battery for actuating the powered actuator.
• In some implementations in which the power-driven instrument head is coupled to a flexible torque coil that couples the power-driven instrument head to a powered actuator that resides outside of the endoscope, the powered actuator can be a part of the instrument control unit.
• In various embodiments of the present disclosure, an endoscope, comprises a first end and a second end separated by a flexible housing, an instrument channel extending from the first end to the second end, and an endoscopic instrument comprising a debriding component and a sample retrieval conduit disposed within the instrument channel. The endoscopic instrument may further include a flexible tubing in which the sample retrieval conduit is partially disposed, the flexible tubing extending from the first end to the second end of the endoscope. The flexible tubing may also include a pneumatic air entry conduit and a fluid irrigation conduit. In various embodiments, the debriding component may include a turbine assembly and a cutting tool. In various embodiments in which the endoscope is configured to have a built in endoscopic instrument, the instrument channel may have a diameter that is larger than the instrument channels of existing endoscopes. In this way, larger portions of debrided material may be suctioned from within the patient's body without clogging the suction conduit.
• In other embodiments, an endoscope may include a first end and a second end separated by a flexible housing; an instrument channel extending from the first end to the second end; and an endoscopic instrument coupled to the instrument channel at the first end of the endoscope, the endoscopic instrument comprising a debriding component and a sample retrieval conduit partially disposed within the instrument channel. In some embodiments, the endoscopic instrument may be removably attached to the endoscopic instrument.
• In other embodiments of the present disclosure, an endoscopic system, includes an endoscope comprising a first end and a second end separated by a flexible housing and an instrument channel extending from the first end to the second end and an endoscopic instrument coupled to the instrument channel at the first end of the endoscope. The endoscopic instrument may include a debriding component and a flexible tubing having a length that is greater than the length of the endoscope. Moreover, the flexible tubing may include a sample retrieval conduit, an pneumatic air entry conduit, and a fluid irrigation conduit, a disposable cartridge configured to couple with the sample retrieval conduit proximal the second end of the endoscope, a pressurized air source configured to couple with the pneumatic air entry conduit proximal the second end of the endoscope, and a fluid irrigation source configured to couple with the fluid irrigation conduit proximal the second end of the endoscope. In various embodiments, the endoscope may also include at least one camera source and at least one light source. In some embodiments of the present disclosure, the pneumatic air entry conduit supplies pressurized air to a turbine assembly of the debriding component proximal the first end of the endoscope and the fluid irrigation conduit supplies irrigation fluid to the sample retrieval conduit proximal the first end of the endoscope.
• As described above with respect toFIGS. 19A-19C, the endoscopic tool can include a flexible cable that can be configured to be driven by a powered actuator that resides outside the endoscopic tool itself. The flexible cable can be a torque coil or rope.
• FIGS.21AA-21F illustrate aspects of an endoscopic assembly. In particular, FIGS.21AA-21F illustrate various views of anendoscopic tool2110 coupled to apowered actuator2120 encased in a housing2150. As shown inFIG. 21, thepowered actuator2120 can be a motor that is operatively coupled to a flexible cable via a pulley system. A casing2150 including one or more structures, such as abase plate2152, one ormore side plates2154 and atop plate2156 can encase themotor2120. Acoupling component2130 can be configured to couple theflexible cable2114 to themotor2120, while providing a suction mechanism to remove any fluids passing through theendoscopic tool2110. Thecoupling component2130 can include asuction port2170 through which fluid within theendoscopic tool2110 can be removed and collected. InFIG. 21B, a pair ofpulleys2160 and2162 coupled to atiming belt2164 are configured such that rotational energy from the motor is transferred to one end of theflexible cable2114. The other end of theflexible cable2114 can be coupled to a cuttingmember2112. Additional details regarding theflexible cable2114 are described herein with respect toFIGS. 22A-22H.
• FIGS. 22A-22H show various implementations of example flexible cables. In some implementations, the flexible cable can be made of three separate threads or wires. An inner wire can have a left-hand wound, a middle wire can have a right-hand wound and the outer wire can have a left-hand wound. In some implementations, the inner wire can have a right-hand wound, a middle wire can have a left-hand wound and the outer wire can have a right-hand wound. In some implementations, the flexible cable can be made of two separate threads or wires. In some such implementations, the inner wire can have a left-hand wound and the outer wire can have a right-hand wound. In some other implementations, the inner wire can have a right-hand wound and the outer wire can have a left-hand wound. In some implementations, the wirerope strands can be twisted in either Z-lay or S-lay. Examples of flexible cables include wireropes and torque coils manufactured by ASAHI INTECC. In some implementations, the outer diameter of the torque rope or coil is limited by the size of the working channel of the endoscope with which the endoscopic tool will be used. Other size considerations that need to be taken into account include providing enough space for the aspiration channel, irrigation channel, amongst others. In some implementations, the outer diameter of the torque coil or torque rope can range between 0.1 mm and 4 mm. In some implementations, the torque coil or rope can have an outer diameter of 0.5 mm to 2.0 mm.
• Referring back toFIG. 21D, a cross-sectional view of thecoupling component2130 is shown. Thecoupling component2130 couples one end of the endoscopic tool to thepowered actuator2120 via thepulleys2160 and2162 and to thesuction port2170. The coupling component includes acollection chamber2181, which is where fluid within the aspiratingtube2118 of theendoscopic tool2110 can be collected before being suctioned out from thecoupling component2130. The coupling component includes acollection chamber2181 can also include adrive shaft2186 that is configured to engage with thepulley2162. The flexible cable ortorque rope2114 can be coupled to one end of thedrive shaft2186. An opposite end of thedrive shaft2186 is coupled to thepulley2162, such that the drive shaft is operatively coupled with themotor2120. In this way, as the motor rotates, the pulleys and thetiming belt2164 are configured to rotate thedrive shaft2186, and in turn, thetorque rope2114.FIGS. 24A-24C illustrate various aspects of the drive shaft of thecoupling component2130. As shown inFIGS. 24A-24C, thedrive shaft2186 can be configured to receive one end of the flexible cable via anopening2406. A pair ofholes2402aand2402bcan be configured to receive set screws or other securing members for securing the flexible cable to thedrive shaft2186.
• Thecoupling component2130 also includes ahousing component2500 that couples a flexible portion of the endoscopic tool to thesuction port2170 via anopening2502.FIG. 25 illustrates anexample housing component2500.
• FIGS. 26A-26E show an example sleeve bearing.
• FIGS. 27A-27C show anexample base plate2152 that forms a portion of the casing.FIGS. 28A-28D show an example side plate that forms a portion of the casing. The side plate can also serve as a feedthrough mount.
• In some implementations, the coupling component is a part of the endoscopic tool. In some implementations, the coupling component is coupled to a flexible portion of the endoscopic tool via a compressionfitting component2182.
• The flexible portion of the endoscopic tool includes an outer tubing, which includes anaspiration tube2118, thetorque rope2114 and asheath2116 that surrounds the outer circumference of thetorque rope2114. The sheath can help reduce friction or the formation of kinks. Theaspiration tube2118 is configured to couple to acutting tool2190 such that material that enters into thecutting tool2190 via anopening2193 can pass through the length of theendoscopic tool2110 via theaspiration tube2118.
• As shown inFIGS. 21E-21F, the torque rope is configured to be coupled to aninner cannula2192 that forms a portion of the cutting tool. Theinner cannula2192 can be surrounded by or disposed within theouter cannula2191. Theopening2193 is formed within theouter cannula2191 at one end of thecutting tool2190. Details of thecutting tool2190 have been provided herein. FIGS.23AA-23BB show an example implementation of a cutting tool. The cutting tool can be any type of cutting tool used in existing medical devices. The cutting tool shown in FIGS.23AA-23BB are shown only for the sake of example and the present disclosure is not intended to be limited to such sizes, shapes, or dimension. Commercially available cutting tools can be used. In some implementations, the cutting tools can be modified in length. In some implementations, the inner cannula can be bonded to the ferrule, while the outer cannula can be coupled to the outer aspirating tube. In some implementations, the connection between the outer cannula and the aspiration channel may be sealed to prevent material from leaking through the connection.
• In some implementations, thetorque rope2114 is coupled to theinner cannula2192 via aferrule2194. The ferrule can be a component that couples the torque rope to the inner cannula such that rotational energy within the torque rope is transferred to the inner cannula. Additional details regarding the shape, size and dimensions of the ferrule are shown in FIGS.29AA-29EE. Depending on the size of the torque rope or flexible cable used in theendoscopic tool2110, the shape and size of the ferrule may vary. Further, the ferrules shown in FIGS.29AA-29EE are merely shown for the sake of example and are not intended to be limited to the particular size, shape, or dimensions shown in the Figures. In some implementations, the ends of the torque rope can be inserted into and bonded to short lengths of hypodermic tubing. Doing so can make it easier to attach the ferrule to the distal end, and to clamp onto on the proximal end (towards the drive shaft). In some implementations, a graphite filled cyanoacrylate, such as loctite black max, can be used. Other similar types of materials can also be used instead.
• FIGS.30AA-30C illustrate aspects of an endoscopic assembly in which the tip is press-fit. In some implementations, the flexible portion of the endoscopic tool can include a balloon structure that can be deployed such that the balloon structure can engage with the inner walls of the endoscope. The balloon structure can be coupled to anair supply line3006 that is coupled to an air supply source, such that when air is supplied, the balloon can expand and engage with the inner wall of the endoscope. In some implementations, the balloon structure can expand asymmetrically, as shown in FIG.30AA-30AB. In some implementations, the air supply source can be actuated via a foot pedal. Anirrigation line3002 can be configured to supply an irrigation fluid. The irrigation fluid can flow towards the cutting tool, where the irrigation fluid can then flow through thesuction channels3004. The irrigation fluid can prevent the suction channels from blockages. As shown inFIG. 30C, the flexible cable or torque rope can be press fit into a button at one end of the cutting tool.
• FIGS.31AA-31AB and31B-31C illustrate aspects of an endoscopic assembly in which the tip is press-fit. In some implementations, the flexible portion of the endoscopic tool can include a balloon structure that can be deployed such that the balloon structure can engage with the inner walls of the endoscope. The balloon structure can be coupled to an air supply source such that when air is supplied, the balloon can expand and engage with the inner wall of the endoscope. In some implementations, the balloon structure can expand symmetrically, as shown in FIGS.31AA and31AB. An irrigation line can be configured to supply an irrigation fluid. The irrigation fluid can flow towards the cutting tool, where the irrigation fluid can then flow through the suction channels. The irrigation fluid can prevent the suction channels from blockages. As shown inFIG. 31C, the flexible cable or torque rope can be welded to one end of the cutting tool.
• FIG. 32 shows a top view of an example flexible portion of an endoscopic tool. In some implementations, the flexible portion shown inFIG. 32 can be used with the implementations shown in FIGS.30AA-30C and31AA-31AB and31B-31C. Theflexible portion3202 includes a center channel3204 through which the flexible cable passes through. Theflexible portion3202 also includes twoaspiration channels3406aand3406b, anirrigation channel3408 and anair supply channel3410.
• In some implementations, the operating speed of the torque rope can vary. In some example implementations, the torque rope can have an operating speed within the range of 0.5 k RPM to 20 k RPM. In some implementations, the torque rope can have an operating speed within the range of 1 k RPM and 4 k RPM. In some implementations, the operating speed of the torque rope can vary. In some example implementations, the torque rope can operate with a torque of 5 to 100 mN*m (milliNewton Meters). In some implementations, the torque rope can operate with a torque of 20 to 50 mN*m (milliNewton Meters). However, it should be appreciated by those skilled in the art that the torque and running speed of the flexible cable can be altered based on the performance of the endoscopic tool. In some implementations, various factors contribute to the performance of the endoscopic tool, including the amount of suction, the type of cutter, the size of the opening in the cutter, amongst others. As such, the torque and running speed at which to operate the flexible cable can be dependent on a plurality of factors.
• FIG. 33 is a cross-sectional view of an example cutting assembly of an endoscopic tool using a torque rope. The cuttingassembly3300 includes anouter cannula3302, aninner cannula3304 including aninner cutter3306 disposed within theouter cannula3302, aPTFE bearing3308, asemi-compliant balloon3310, and amultilumen extrusion3312. Atorque rope3314 can be coupled to theinner cutter3306. The diameter of the outer cannula can be between 0.05 inches to a size suitable to pass through an instrument channel of an endoscope.
• FIGS. 34A-34C are cross-sectional views of different configurations of the flexible portion region of one implementation of an endoscopic tool described herein. The flexible portion region can include anaspiration lumen3402, aninflation lumen3404, a lavage orirrigation lumen3406 and a torque rope.
• FIGS.35AA-35AC show various views of portions of an endoscopic tool. The endoscopic tool can include anouter cannula1, aninner cutter2, aninner cannula3, atorque rope4, atrilumen extrusion5, aballoon6, aPTFE washer7, twosidearms8, aproximal plug9, anPTFE gasket10 and agasket cap11.
• FIG. 36 shows a cross-sectional view of the flexible portion region of one implementation of an endoscopic tool described herein. The flexible portion region can include anouter inflation jacket3602, anouter coil3604, atorque coil3606, amulti-lumen extrusion3608 disposed within the torque coil. Themulti-lumen extrusion3608 can include alavage lumen3610 and anaspiration lumen3612.
• FIG. 37 shows a cross-section view of one implementation of the endoscopic tool described herein. The endoscopic tool includes anouter cannula3702, aninner cutter3704, aninner torque coil3706, anouter coil3708, an outer inflation jacket andballoon3710, and amulti-lumen extrusion3712. Agear3714, such as a worm gear can engage with the torque coil to drive the inner cutter.
• FIGS. 38A and 38B show various views of a distal portion of one implementation of an endoscopic tool described herein. The endoscopic tool includes anouter cutter3802 that defines anopening3804. The endoscopic tool also includes aninner cutter3806 disposed within the outer cutter. The inner cutter is coupled to atorque coil3808. The torque coil is disposed within a PET heat shrink3810 or other type of tubing. The outer cutter is coupled to abraided shaft3812 to allow theouter cutter3802 to rotate relative to theinner cutter3806.
• FIGS. 39A and 39B show cross-sectional views of the distal portion of the endoscopic tool shown inFIGS. 38A and 38B along the sections B-B and sections C-C.
• In some implementations, an endoscopic instrument insertable within a single instrument channel of an endoscope can include a power driven instrument head or cutting assembly that is configured to resect material at a site within a subject. The cutting assembly includes an outer cannula and an inner cannula disposed within the outer cannula. The outer cannula defines an opening through which material to be resected enters the cutting assembly. The endoscopic instrument also includes a flexible outer tubing coupled to the outer cannula and configured to cause the outer cannula to rotate relative to the inner cannula. The flexible outer tubing can have an outer diameter that is smaller than the instrument channel in which the endoscopic instrument is insertable. The endoscopic instrument also includes a flexible torque coil having a portion disposed within the flexible outer tubing. The flexible torque coil having a distal end coupled to the inner cannula. The flexible torque coil is configured to cause the inner cannula to rotate relative to the outer cannula. The endoscopic instrument also includes a proximal connector coupled to a proximal end of the flexible torque coil and configured to engage with a drive assembly that is configured to cause the proximal connector, the flexible torque coil and the inner cannula to rotate upon actuation. The endoscopic instrument also includes an aspiration channel having an aspiration port configured to engage with a vacuum source. The aspiration channel is partially defined by an inner wall of the flexible torque coil and an inner wall of the inner cannula and extends from an opening defined in the inner cannula to the aspiration port. The endoscopic instrument also includes an irrigation channel having a first portion defined between an outer wall of the flexible torque coil and an inner wall of the flexible outer tubing and configured to carry irrigation fluid to the aspiration channel.
• In some implementations, the proximal connector is hollow and an inner wall of the proximal connector defines a portion of the aspiration channel. In some implementations, the proximal connector is a rigid cylindrical structure and is configured to be positioned within a drive receptacle of the drive assembly. The proximal connector can include a coupler configured to engage with the drive assembly and a tensioning spring configured to bias the inner cannula towards a distal end of the outer cannula. In some implementations, the tensioning spring is sized and biased such that the tensioning spring causes a cutting portion of the inner cannula to be positioned adjacent to the opening of the outer cannula. In some implementations, the proximal connector is rotationally and fluidly coupled to the flexible torque coil. In some implementations, the tensioning spring can be sized and biased such that the distal tip of the inner cannula can contact the inner distal wall of the outer cannula. This may limit any lateral or undesired movement generated due to whip at the distal end of the inner cannula caused by the rotation of the flexible torque coil.
• In some implementations, the endoscopic instrument also includes a lavage connector including an irrigation entry port and a tubular member coupled to the lavage connector and the flexible outer tubing. An inner wall of the tubular member and the outer wall of the flexible torque coil can define a second portion of the irrigation channel that is fluidly coupled to the first portion of the irrigation channel. In some implementations, the endoscopic instrument also includes a rotational coupler coupling the flexible outer tubing to the tubular member and configured to cause the flexible outer tubing to rotate relative to the tubular member and cause the opening defined in the outer cannula to rotate relative to the inner cannula. In some implementations, the lavage connector defines an inner bore within which the flexible torque coil is disposed.
• In some implementations, the endoscopic instrument also includes a lining within which the flexible torque coil is disposed, the outer wall of the lining configured to define a portion of the irrigation channel. In some implementations, the inner cannula is configured to rotate about a longitudinal axis of the inner cannula and relative to the outer cannula and the aspiration channel is configured to provide a suction force at the opening of the inner cannula.
• In some implementations, the flexible torque coil includes a plurality of threads. Each of the plurality of threads can be wound in a direction opposite to a direction in which one or more adjacent threads of the plurality of threads is wound. In some implementations, the flexible torque coil includes a plurality of layers. Each of the plurality of layers can be wound in a direction opposite to a direction in which one or more adjacent layers of the plurality of layers is wound. In some implementations, each layer can include one or more threads. Additional details regarding the flexible torque coil are described above in regard to the discussion of the flexible cable with respect to at leastFIGS. 22A-22H.
• In some implementations, the flexible outer tubing has a length that exceeds the length of the endoscope in which the endoscopic instrument is insertable. In some implementations, the flexible outer tubing has a length that is at least 100 times larger than an outer diameter of the flexible outer tubing. In some implementations, the flexible portion is at least 40 times as long as the cutting assembly.
• FIGS. 40A-40B show a perspective view of anendoscopic tool4000 and a portion of adrive assembly4050 configured to drive the endoscopic tool. Referring now also toFIGS. 41,42 and43,FIG. 41 shows a top view of theendoscopic tool4000 and a top exposed view of the portion of thedrive assembly4050 shown inFIGS. 40A-40B.FIG. 42 shows a cross-sectional view of theendoscopic tool4000 and the portion of thedrive assembly4050 across the section A-A.FIG. 43 shows an enlarged view of the drive connector of the endoscope and the portion of thedrive assembly4050.FIG. 44 shows a perspective view of theendoscopic tool4000 and a portion of the drive assembly shown inFIGS. 40A-40B.FIG. 45 shows a cross-sectional view of the endoscopic tool and the portion of the drive assembly across the section B-B.FIG. 46 shows an enlarged cross-sectional view of the rotational coupler section of the endoscopic tool.FIG. 47A andFIG. 47B show a top view and a cross-sectional view of the rotational coupler of the endoscopic tool.
• Theendoscopic tool4000, as shown inFIGS. 40A-47B, may be configured to be inserted within an instrument channel of an endoscope. Examples of the endoscope can include a gastroscope, such as a colonoscope, a laryngoscope, or any other flexible endoscope. The endoscopic tool can include aflexible portion4002 that is shaped, sized and configured to be inserted within the instrument channel, while a remaining portion of theendoscopic tool4000 can be configured to remain outside the instrument channel of the endoscope. Theflexile portion4002 can be shaped and sized to fit within the instrument channel and be configured to navigate through a tortuous path defined by the instrument channel while the endoscope is inserted within the patient. In the case of colonoscopes, the endoscope can form a series of bends of over at least 60 degrees and in some situations, over 90 degrees.
• Theendoscopic tool4000 can include acutting assembly4010 configured to resect material at a site within a subject. The cuttingassembly4010 can be similar to the cuttingassembly160 described inFIG. 1C and elsewhere in the description and figures. In some implementations, the cuttingassembly4010 can include an outer cannula and an inner cannula disposed within the outer cannula. The outer cannula can define anopening4012 through which material to be resected can enter thecutting assembly4010. In some implementations, theopening4012 is defines through a portion of the radial wall of the outer cannula. In some implementations, the opening may extend around only a portion of the radius of the outer cannula, for example, up to one third of the circumference of the radial wall. As theaspiration channel4090 extends between theaspiration port4092 and theopening4012, any suction applied at theaspiration port4092 causes a suction force to be exerted at theopening4012. The suction force causes material to be introduced into the opening of the outer cannula, which can then be cut by the inner cannula of the cutting assembly.
• The inner cannula can include a cutting section that is configured to be positioned adjacent to theopening4012 such that material to be resected that enters the cutting assembly via theopening4012 can be resected by the cutting section of the inner cannula. The inner cannula may be hollow and an inner wall of the inner cannula may define a portion of an aspiration channel that may extend through the length of the endoscopic tool. A distal end of the inner cannula can include the cutting section while a proximal end of the inner cannula can be open such that material entering the distal end of the inner cannula via the cutting section can pass through the proximal end of the inner cannula. In some implementations, the distal end of the inner cannula can come into contact with an inner surface of a distal end of the outer cannula. In some implementations, this can allow the inner cannula to rotate relative to the outer cannula along a generally longitudinal axis, providing more stability to the inner cannula while the inner cannula is rotating. In some implementations, the size of the opening can dictate the size of the materials being cut or resected by the inner cannula. As such, the size of the opening may be determined based in part on the size of the aspiration channel defined by the inner circumference of the flexible torque coil.
• Theendoscopic instrument4000 can include aflexible torque coil4080 that is configured to couple to the proximal end of the inner cannula at a distal end of theflexible torque coil4080. The flexible torque coil can include a fine coil with multiple threads and multiple layers, which can transmit the rotation of one end of the flexible torque coil to an opposite end of the flexible torque coil. Each of the layer of thread of the flexible torque coil can be wound in a direction opposite to a direction in which each of the layer of thread adjacent to the layer of thread is wound. In some implementations, the flexible torque coil can include a first layer of thread wound in a clockwise direction, a second layer of thread wound in a counter-clockwise direction and a third layer of thread wound in a clockwise direction. In some implementations, the first layer of thread is separated from the third layer of thread by the second layer of thread. In some implementations, each of the layers of thread can include one or more threads. In some implementations, the layers of thread can be made from different materials or have different characteristics, such as thickness, length, among others.
• The flexibility of thetorque coil4080 allows the coil to maintain performance even in sections of thetorque coil4080 that are bent. Examples of theflexible torque coil4080 include torque coils made by ASAHI INTECC USA, INC located in Santa Ana, Calif., USA. In some implementations, theflexible torque coil4080 can be surrounded by a sheath or lining to avoid frictional contact between the outer surface of theflexible torque coil4080 and other surfaces. In some implementations, theflexible torque coil4080 can be coated with Polytetrafluoroethylene (PFTE) to reduce frictional contact between the outer surface of theflexible torque coil4080 and other surfaces. Theflexible torque coil4080 can be sized, shaped or configured to have an outer diameter that is smaller than the diameter of the instrument channel of the endoscope in which the endoscopic tool is to be inserted. For example, in some implementations, the outer diameter of the flexible torque coil can be within the range of 1-4 millimeters. The length of the flexible torque coil can be sized to exceed the length of the endoscope. In some implementations, the inner wall of theflexible torque coil4080 can be configured to define another portion of the aspiration channel that is fluidly coupled to the portion of the aspiration channel defined by the inner wall of the inner cannula of the cuttingassembly4010. A proximal end of theflexible torque coil4080 can be coupled to aproximal connector assembly4070, details of which are provided below.
• Theendoscopic instrument4000 can include a flexibleouter tubing4086 that can be coupled to the proximal end of the outer cannula. In some implementations, a distal end of the flexibleouter tubing4086 can be coupled to the proximal end of the outer cannula using a coupling component. In some implementations, the outer cannula can be configured to rotate responsive to rotating the flexible outer tubing. In some implementations, the flexibleouter tubing4086 can be a hollow, braided tubing that has an outer diameter that is smaller than the instrument channel of the endoscope in which theendoscopic instrument4000 is to be inserted. In some implementations, the length of the flexibleouter tubing4086 can be sized to exceed the length of the endoscope. The flexibleouter tubing4086 can define a bore through which a portion of the flexibleouter tubing4086 extends. The flexibleouter tubing4086 can include braids, threads, or other features that facilitate the rotation of the flexibleouter tubing4086 relative to the flexible torque coil, which is partially disposed within the flexibleouter tubing4086.
• Theendoscopic instrument4000 can include arotational coupler4030 configured to be coupled to a proximal end of the flexibleouter tubing4086. Therotational coupler4030 may be configured to allow an operator of the endoscopic tool to rotate the flexibleouter tubing4086 via arotational tab4032 coupled to or being an integral part of therotational coupler4030. By rotating therotational tab4032, the operator can rotate the flexible outer tubing and the outer cannula along a longitudinal axis of the endoscope and relative to the endoscope and the inner cannula of the cuttingassembly4010. In some implementations, the operator may want to rotate the outer cannula while the endoscopic instrument is inserted within the endoscope while the endoscope is within the patient. The operator may desire to rotate the outer cannula to position the opening of the outer cannula to a position where the portion of the radial wall of the outer cannula within which the opening is defined may aligned with the camera of the endoscope such that the operator can view the material entering the endoscopic instrument for resection via the opening. This is possible in part because the opening is defined along a radial wall extending on a side of the outer cannula as opposed to an opening formed on the axial wall of the outer cannula.
• In some implementations, aproximal end4034 of therotational coupler4030 can be coupled to alavage connector4040. In some implementations, therotational coupler4030 can be a rotating luer component that allows adistal end4036 of therotational coupler4030 rotate relative to theproximal end4034 of therotational coupler4030. In this way, when the flexibleouter tubing4086 is rotated, the component to which the proximal end of therotational coupler4030 is coupled, is not caused to rotate. In some implementations, theproximal end4034 of therotational coupler4030 can be coupled to anouter tubular member4044 configured to couple theproximal end4034 of therotational coupler4030 to thelavage connector4040. Therotational coupler4030 can define a bore along a central portion of therotational coupler4030 through which a portion of theflexible torque coil4080 extends. In some implementations, therotational coupler4030 can be a male to male rotating luer connector. In some implementations, the rotational coupler can be configured to handle pressures up to 1200 psi.
• Thelavage connector4040 can be configured to introduce irrigation fluid into theendoscopic tool4000. Thelavage connector4040 includes alavage port4042 configured to engage with an irrigation source, such as a water container. In some implementations, thelavage connector4040 can be a Y port used in fluid delivery systems that complies with medical device industry standards and is sized to couple to the flexibleouter tubing4086 or theouter tubular member4044 that serves to couple adistal end4048 of thelavage connector4040 to theproximal end4034 of therotational coupler4030. In some implementations, the lavage connector can define a hollow channel between theproximal end4046 and thedistal end4048 of thelavage connector4040 that is sized to allow theflexible torque coil4080 to pass through the hollow channel defined through thelavage connector4040.
• As described above, theproximal connector assembly4070 is configured to be coupled to a proximal end of theflexible torque coil4080. Theproximal connector assembly4070 can be configured to engage with thedrive assembly4050 that is configured to provide torque to the inner cannula via theproximal connector assembly4070 and theflexible torque coil4080. Theproximal connector assembly4070 can further define a portion of the aspiration channel and be configured to fluidly couple the aspiration channel to a vacuum source to facilitate the removal of material entering the aspiration channel. In some implementations, a proximal end of theproximal connector assembly4070 can include anaspiration port4092 through which the material that enters theendoscopic tool4000 can be withdrawn from theendoscopic tool4000.
• In some implementations, theendoscopic tool4000 can be configured to be driven by thedrive assembly4050. Thedrive assembly4050 is configured to provide rotational energy from an energy source to theendoscopic tool4000. Thedrive assembly4050 can include ahousing4060 that may house a firstbeveled gear4054 and a secondbeveled gear4056 that are positioned such that the rotation of the firstbeveled gear4054 causes a rotation of thesecond beveled gear4056. Thesecond beveled gear4056 can be coupled to a drive receptacle that is sized and shaped to receive and engage with theproximal connector assembly4070 of theendoscopic tool4000. In some implementations, the firstbeveled gear4054 can be coupled to a motor (not shown) or other rotational source via arotational input shaft4052.
• Theproximal connector assembly4070 can include ahollow drive shaft4072, acoupler4076 through which thehollow drive shaft4072 passes and atensioning spring4074 coupled to thehollow drive shaft4072. A distal end of thedrive shaft4072 can be coupled to the proximal end of theflexible torque coil4080. In some implementations, thedrive shaft4072 and theflexible torque coil4080 can be permanently coupled to one another. In some implementations, thedrive shaft4072 andflexible torque coil4080 can be coupled using a coupler, a press fit, a weld, such as a butt weld, or any other attachment means that allows theflexible torque coil4080 to rotate when thedrive shaft4072 rotates and to allow material passing through theflexible torque coil4080 to flow through thedrive shaft4072. A proximal end of thedrive shaft4072 can define theaspiration port4092. In some implementations, theaspiration port4092 can be configured to engage with a vacuum source causing material entering theopening4012 to flow through theaspiration channel4090 and out of the endoscopic tool through theaspiration port4092.
• Acoupler4076, such as a hex-shaped coupler, can be configured to couple with the hollow drive shaft. In some implementations, the hex-shaped coupler is a part of the hollow drive shaft. Thecoupler4076 can include an outer wall that is configured to engage with an inner wall of adrive receptacle4058. Thedrive receptacle4058 is coupled to thesecond beveled gear4056 and is configured to rotate when thesecond beveled gear4056 rotates. In some implementations, thedrive receptacle4058 can be a hollow cylindrical tube. In some implementations, aproximal end4059 of thedrive receptacle4058 can include an opening defined by an inner wall of the proximal end of thedrive receptacle4058 that has a diameter that smaller than the inner diameter of the remaining portion of thedrive receptacle4058. In some implementations, the diameter of the opening through theproximal end4059 of thedrive receptacle4058 can be large enough to receive thedrift shaft4072 but small enough to prevent thetensioning spring4074 coupled to thedrive shaft4072 from passing through the opening. In some implementations, the inner diameter of the remaining portion of the drive receptacle is sized to engage with thecoupler4076.
• Thetensioning spring4074 can be biased in such a way that, during operation of theendoscopic tool4000, thetensioning spring4074 may prevent thedrive shaft4072, theflexible torque coil4080 and the inner cannula from sliding towards the proximal end of theendoscopic tool4000. In some implementations, without thetensioning spring4074, the inner cannula may slide away from the distal end of theendoscopic tool4000. This may be due to a force applied by the material to be resected at theopening4012. In some implementations, thetensioning spring4074 provides a countering force that prevents the inner cannula from sliding away from the distal end when the inner cannula comes into contact with the material to be resected at theopening4012. In some implementations, thetensioning spring4074 can be configured to bias the distal end of the inner cannula to contact an inner wall of the distal end of the outer cannula. In some implementations, thetensioning spring4074 can be sized and biased such that the distal tip of the inner cannula can contact the inner distal wall of the outer cannula. This may limit any lateral or undesired movement generated due to whip at the distal end of the inner cannula caused by the rotation of the flexible torque coil.
• Thehousing4060 can be configured to engage with anaspiration end cap4062 and alocking collar4064. In some implementations, theaspiration end cap4062 can be configured to allow a vacuum source to maintain a secure connection with theaspiration port4092 of thedrive shaft4072. In some implementations, theaspiration end cap4062 can be configured to allow thedrive shaft4072 to rotate while maintaining a secure connection between the vacuum source and theaspiration port4092 of thedrive shaft4072. In some implementations, theaspiration end cap4062 can be configured to be secured to a portion of thehousing4060 in such a way that the aspiration port of thedrive shaft4072 is accessible via an opening of theaspiration end cap4062. In some implementations, the vacuum source can be coupled to theend cap4062 such that the vacuum source does not rotate along with the proximal end of thedrive shaft4072. In some implementations, one or more bearings or bushings can be used to allow facilitate a fluid connection between theaspiration port4092 of thedrive shaft4072 and the vacuum source without causing the vacuum source to rotate with thedrive shaft4072.
• Thelocking collar4064 can be configured to secure thelavage connector4040 to theproximal connector assembly4070. In some implementations, thelocking collar4064 can be configured to secure aproximal end4046 of thelavage connector4040 to thehousing4060 of thedrive assembly4050. Thelocking collar4064 can further be configured to prevent theproximal connector assembly4070 from disengaging with thedrive receptacle4058 and moving towards the distal end of theendoscopic tool4000. In some implementations, thelocking collar4064 can be configured to secure alining4082 within which theflexible torque coil4080 is disposed to theflexible torque coil4080, thedrive shaft4072 or thehousing4060. In some implementations, the lining4082 can serve as a heat shrink to reduce the dissipation of heat generated in the flexible torque coil to other components of the endoscopic tool. In some implementations, the outer wall of thelining4082 can define a portion of the irrigation channel, while the inner wall of thelining4082 can serve to prevent any material passing through the aspiration channel from escaping through the walls of the flexible torque coil. In some implementations, the lining4082 can also prevent the irrigation fluid passing through the irrigation channel to flow into theaspiration channel4090 through the walls of theflexible torque coil4080.
• Thedistal end4048 of thelavage connector4040 can be configured to engage with an inner wall of theouter tubing4044. In some implementations, thedistal end4048 of thelavage connector4040 can be press fit into a proximal end of theouter tubing4044. In some implementations, a connector connecting thedistal end4048 of thelavage connector4040 and the outer tubing can be used. The inner wall of theouter tubing4044 and the outer wall of thelining4082 can define a portion of theirrigation channel4096. Theouter tubing4044 can extend from thedistal end4048 of thelavage connector4040 to aproximal end4034 of therotational coupler4030. The distal end of theouter tubing4044 can be configured to engage with theproximal end4034 of therotational coupler4030.
• In some implementations, the irrigation channel can extend from the irrigation entry port to the opening of the outer cannula. The irrigation channel can be defined by the inner wall of the outer tubular member, the rotational coupler, the inner wall of the outer tubing and the inner wall of outer cannula. In some implementations, the irrigation channel can also be defined by the outer wall of the inner cannula and the outer wall of theflexible torque coil4080. In some implementations, theendoscopic instrument4000 can also include thehollow lining4082 that is sized to fit around theflexible torque coil4080. In some implementations, thehollow lining4082 can serve as a barrier between theirrigation channel4096 and theaspiration channel4090. In some implementations, thehollow lining4082 can prevent air or other fluids to seep through the threads of theflexible torque coil4080. In addition, the hollow lining can allow the aspiration channel to maintain a suction force throughout the length of the aspiration channel by preventing air to escape or enter through the threads of theflexible torque coil4080.
• As described above, the cuttingassembly4010 includes the outer cannula. Thebraided tubing4086 is coupled to the outer cannula such that rotating therotational tab4032 of therotational coupler4030 results in rotating the outer cannula. The outer cannula includes theopening4012 at a distal end of the outer cannula. The opening is defined within a portion of the radial wall of the outer cannula and may only extend around a portion of the radius of the outer cannula. As theaspiration channel4090 extends between theaspiration port4092 and theopening4012, any suction applied at theaspiration port4092 causes a suction force to be exerted at theopening4012. The suction force causes material to be introduced into the opening of the outer cannula, which can then be cut by the inner cannula of the cutting assembly. In some implementations, the aspirated material can be collected in a collection cartridge. In some implementations, the collection cartridge can be fluidly coupled to the proximal end of the aspiration channel.
• The inner cannula is disposed within the outer cannula and configured to resect any material that is sucked into or otherwise enters theopening4012 due to the suction force in theaspiration channel4090. The inner cannula can cut, resect, excise, debride or shave the material at theopening4012 based in part on the interaction between the cutting surface and the wall of the outer cannula that defines the opening. In some implementations, the rotational movement of the cutting surface relative to theopening4012 can cause the material to be cut, resected, excised, or shaved. The flexible torque coil is coupled to the inner cannula and causes the inner cannula to rotate along the longitudinal axis of the inner cannula. As the outer cannula is coupled to the outer tubing and is not rotationally coupled to the inner cannula or flexible torque coil, the inner cannula rotates relative to the outer cannula. A gap between an outer wall of the inner cannula and the inner wall of the outer cannula defines a portion of the irrigation channel through which irrigation fluid can flow from thelavage connector4040 through the irrigation channel portion defined in part by theouter tubing4044, therotational coupler4030, and the flexibleouter tubing4086 towards the cutting surface of the inner cannula. The inner cannula may define a portion of the aspiration channel through which excised or resected material and the irrigation fluid can flow from the cutting surface of the inner cannula towards theaspiration port4092.
• The length of the cuttingassembly4010 may be sized to allow theendoscopic instrument4000 to traverse through the length of the endoscope while the endoscope is inserted inside a patient. In some implementations, the endoscope may be disposed within the patient and the endoscope may include bends that exceed 60 degrees. As such, the length of the cuttingassembly4010 may not exceed a few centimeters. In some implementations, the length of the cuttingassembly4010 may be less than 1% of the length of theendoscopic tool4000, or the length of the flexible portion of the endoscope within which the endoscopic tool can be inserted. As described above, tissue sensing capabilities can be implemented with the cutting assembly serving as a portion of the tissue sensor.
• It should be appreciated that one or more seals, bearings, and other components may be used. Seals may be used to maintain pressure, prevent fluid leaks, or to securely engage components to one another. In some implementations, bearings may be used to allow components to rotate relative to one another without adversely affecting the components or the performance of the endoscopic tool.
• FIG. 45 shows a cross-sectional view of the endoscopic tool and the portion of the drive assembly across the section B-B. As shown inFIG. 45, thesecond beveled gear4056 may be configured to engage with thedrive receptacle4058 of thedrive assembly4050. Theproximal connector4070 of theendoscopic tool4000, which includes thecoupler4076 and thedrive shaft4072, can be inserted disposed within thedrive receptacle4058. The outer wall of thecoupler4076 is sized to engage with the inner wall of thedrive receptacle4058 such that when thedrive receptacle4058 rotates, thecoupler4076 also rotates. Because thecoupler4076 is coupled to thedrive shaft4072, thedrive shaft4072 may also rotate when thedrive receptacle4058 rotates. The inner wall of the drive shaft defines a portion of theaspiration channel4090.
• FIG. 46 shows an enlarged cross-sectional view of the rotational coupler section of the endoscopic tool.FIG. 47A andFIG. 47B show a top view and a cross-sectional view of the rotational coupler of the endoscopic tool.
• As shown inFIGS. 46-47B, theouter tubing4044 is configured to engage with therotational coupler4030. Theouter tubing4044 surrounds thelining4082, which in turn surrounds theflexible torque coil4080. The inner wall of theflexible torque coil4080 may define a portion of theaspiration channel4090. The space between the inner wall of theouter tubing4044 and the outer wall or surface of thelining4082 defines a portion of the irrigation channel. Thetab4032 can be configured to be rotated by an operator of the endoscopic tool. In some implementations, the operator can rotate thetab4032 while the endoscopic tool is inserted within the instrument channel of the endoscope and cause the outer cannula to rotate relative to the inner cannula and the endoscope. In this way, the operator can position the opening defined through the outer cannula by rotating the outer cannula to a desired position. In some implementations, by providing a mechanism through which the outer cannula can be rotated relative to the endoscope, an operator does not have to be concerned about the position of the opening when the endoscopic tool is inserted within the instrument channel of the endoscope as the operator may be able to adjust the position of the opening by causing the outer cannula to rotate while the endoscopic tool is inserted within the endoscope.
• FIG. 48 is a perspective view of a portion of the endoscopic tool inserted for operation within a drive assembly. Thedrive assembly4800 includes adrive interface4810 configured to receive theproximal connector4070 of theendoscopic tool4000. Theproximal connector4070 can engage with the drive receptacle of thedrive interface4810 to translate rotational energy generated by thedrive assembly4800 to the cutting assembly of theendoscopic tool4000. Thedrive assembly4800 may include apump4820 or other fluid displacement device to control the flow of irrigation fluid into thelavage port4042 of theendoscopic tool4000. In some implementations, thepump4820 can be a peristaltic pump. In some implementations, the pump can be any positive displacement fluid pump. In some implementations, a valve between thepump4820 and thelavage port4042 can be placed to control an amount of irrigation fluid entering the endoscopic tool. In some implementations, the speed at which thepump4820 operates can dictate the rate at which irrigation fluid enters the endoscopic tool. The drive assembly can also include apinch valve4830. In some implementations, the pinch valve can be configured to control the application of a suction force applied to the aspiration channel.
• In some implementations, an actuator, such as a control switch can be used to actuate thedrive assembly4800. In some implementations, the actuator can be a foot pedal, a hand switch, or any other actuation means for controlling thedrive assembly4800. In some implementations, the actuator can be coupled to the drive means, such as thepump4820 such that when the actuator is actuated, thepump4820 begins to rotate, generating torque, which is translated to the proximal connector of the endoscopic tool via thedrive interface4810. The torque applied to the proximal connector can be translated via the flexible torque coil to the inner cannula, thereby causing the inner cannula to rotate relative to the outer cannula. In some implementations, the actuator can be coupled to a pinch valve, such as thepinch valve4830 to control the amount of suction applied to the aspiration channel. In some implementations, the actuator can be configured to actuate both the drive means and the pinch valve simultaneously, such that the inner cannula is rotating while suction is applied through the aspiration channel. In some implementations, the actuator can also be coupled to an irrigation control switch or valve that controls the flow of irrigation fluid into the endoscopic tool via theirrigation entry port4042. In some implementations, the actuator can be configured to actuate the drive means, the pinch valve for aspiration and the irrigation control switch for irrigation simultaneously, such that the inner cannula is rotating while suction is applied through the aspiration channel and irrigation fluid is supplied to the endoscopic tool.
• In some implementations, a separate irrigation control switch can be configured to control the flow of irrigation fluid through the irrigation channel of the endoscopic tool. An operator can control the volume of irrigation fluid provided to the irrigation channel via the irrigation control switch.
• The drive assembly configuration shown inFIGS. 40-48 is one example configuration of a drive assembly. It should be appreciated that theendoscopic tool4000 can be configured to be driven by other drive assembly configurations. In some implementations, the proximal connector portion of theendoscopic tool4000 can be modified to engage with other drive assembly configurations. In some implementations, the endoscopic tool400 can be configured to be packaged as one or more different components that can be assembled prior to inserting the endoscopic tool within the instrument channel of the endoscope. In some implementations, the proximal connector of theendoscopic tool4000 can be assembled together by an operator of the endoscopic tool after one or more components of the endoscopic tool are caused to engage with components of the drive assembly.
• FIG. 49 illustrates another implementation of the endoscopic tool and a drive assembly configured to drive the endoscopic tool.FIG. 50A is a side view of the endoscopic tool and drive assembly shown inFIG. 49.FIG. 50B is a cross-sectional view of the endoscopic tool and drive assembly shown inFIG. 49 taken along the section A-A. Theendoscopic tool4910 is similar to theendoscopic tool4000 but differs from theendoscopic tool4000 in that theendoscopic tool4910 has a differentproximal connector4912. In this implementation, theproximal connector4912 can be coupled to a flexible torque coil, similar to the flexible torque coil of theflexible torque coil4000 shown inFIGS. 40-43, and include a proximalconnector engagement structure4914 that is configured to engage with adrive assembly4950. The proximal connector engagement structure can be sized to engage with thedrive assembly4950 and include one or more engagement surfaces configured to engage with thedrive assembly4950. The engagement surfaces can be coupled to the drive shaft included within theproximal connector4912 such that when thedrive assembly4950 applies a rotating force to the engagement surfaces, the drive shaft rotates, which in turn causes the flexible torque coil and cutting assembly of theendoscopic tool4900 to rotate. In some implementations, theengagement surfaces4914 can be cylindrical objects having an outer wall configured to engage with thedrive assembly4950 and an inner wall configured to engage with an outer wall of the drive shaft. In some implementations, theproximal connector4910 can also include afin4916 or other structure that prevents theproximal connector4910 andendoscopic tool4910 from rotating relative to thedrive assembly4950. In some implementations, a side of thefin4916 can rest on or engage with a mountingstructure4936aand4936b. In this way, when a rotating force is applied by the drive assembly on the engagement surfaces, thefin4916 prevents theproximal connector4910 from rotating relative to thedrive assembly4950. The mountingstructures4936 can be configured such that various components of thedrive assembly4950 can be mounted on or receive support from the mountingstructures4936.
• Thedrive assembly4950 can include aretractable arm4922, one or more spring loadedbearings4924, adrive belt4932 and adrive wheel4936 and one or morestationary bearings4940. Theretractable arm4922 can be configured to rotate between a first position and a second position. The spring loadedbearings4924 can be mounted to theretractable arm4922 and positioned such that when theretractable arm4922 is in the first position as shown in FIGS.49 and50A-B, the spring loadedbearings4924 can apply a force on theproximal connector4912 causing the proximal connector to remain in place while thedrive assembly4950 is actuated. The spring loadedbearings4924 can be positioned such that when theproximal connector4912 of theendoscopic tool4910 is engaged with thedrive assembly4950, the spring loadedbearings4924 engage with anengagement component4916 of a drive shaft (not shown) disposed within theproximal connector4912. Theengagement component4916 can be strategically located on theproximal connector4912 such that when theretractable arm4922 is in the first position, the spring loadedbearings4924 come into contact with theengagement component4916. Theengagement component4916 can be cylindrical in shape and surround the drive shaft disposed within theproximal connector4912. Theengagement component4916 can form a portion of the outer wall of theproximal connector4912. In some implementations, theengagement component4916 can rotate along a longitudinal axis of theproximal connector4912 and rotate relative to theproximal connector4912. In some implementations, thedrive wheel4936 can be an elastomeric friction drive wheel.
• A drive means, such as a motor or other driving source, can drive thedrive wheel4936 mounted on a mountingshaft4930 via thedrive belt4934 that moves when the drive means is actuated. Thedrive belt4934 can cause thedrive wheel4936 to rotate. Theengagement component4916 of theproximal connector4912 can be configured to contact thedrive wheel4936 when the endoscopic tool is positioned within thedrive assembly4950. Astationary bearing4940 of thedrive assembly4950 can be positioned to hold theproximal connector4912 in place while the rotation of thedrive wheel4936 causes theengagement component4916 to rotate. Thestationary bearing4940 can also provide a force causing thedrive wheel4936 and theengagement component4916 to maintain contact.
• As shown inFIG. 50B, when the retractable arm is in the first position, or engaged position, the spring loadedbearings4924 are in contact with the one ormore engagement components4916 at a first side and thedrive wheel4936 is in contact with theengagement components4916 at a second side. The spring loaded bearings may allow theengagement components4916 to rotate when the drive wheel is rotating. Thefin4914 rests against the mounting structures of the drive assembly preventing the endoscopic tool from rotating. When the retractable arm is in a second position, or disengaged position, the spring loadedbearings4924 are not in contact with the one ormore engagement components4916. As such, the endoscopic tool is not securely positioned within the drive assembly, and as such, actuating the drive means may not cause the flexible torque coil within the endoscopic tool to rotate.
• It should be appreciated that the outer diameter of the endoscopic instrument may be sized to be inserted within the instrument channel of an endoscope while the endoscope is inserted within a patient. In addition, the endoscopic instrument may be sized to be large enough that the endoscopic tool comes into contact with the inner walls of the instrument channel at various portions of the instrument channel to maintain stability of the endoscopic instrument. If the outer diameter of the endoscopic instrument is much smaller than the inner diameter of the instrument channel, there may be a large amount of space between the endoscopic instrument and the inner wall of the instrument channel, which may allow the endoscopic instrument to move, vibrate or otherwise experience some instability during operation.
• It should be appreciated that the FIGURES shown herein are intended to be for illustrative purposes only and are not intended to limit the scope of the application in any way. In addition, it should be appreciated that the dimensions provided herein are only example dimensions and can vary based on specific requirements. For example, the dimensions may change to alter the aspiration rate, irrigation flow, amount of torque being provided, cutting speed, cutting efficiency, amongst others. Moreover, it should be appreciated that details within the drawings are part of the disclosure. Moreover, it should be appreciated that the shape, materials, sizes, configurations and other details are merely illustrated for the sake of examples and persons having ordinary skill in the art should appreciate that design choices can alter any of the shape, materials, sizes and configurations disclosed herein. For the purpose of this disclosure, the term “coupled” means the joining of two members directly or indirectly to one another. Such joining may be stationary or moveable in nature. Such joining may be achieved with the two members or the two members and any additional intermediate members being integrally formed as a single unitary body with one another or with the two members or the two members and any additional intermediate members being attached to one another. Such joining may be permanent in nature or may be removable or releasable in nature.
• Although the present disclosure is directed towards endoscopic instruments adapted for use with any type of endoscope, for sake of convenience, the teachings of the present disclosure are directed towards endoscopic instruments used with a lower GI scope, such as a colonoscope. It should, however, be appreciated that the scope of the present disclosure is not limited to endoscopic instruments for use with GI scopes, but extends to any type of flexible or rigid endoscope, including but not limited to bronchoscopes, gastroscopes and laryngoscopes, hysteroscopes, or other medical devices that may be used to treat patients.
Integrated Torque Generation Component
• Aspects of the present disclosure are related to endoscopes configured to include a torque generation component formed within an insertable portion of the endoscope that is insertable within a mammalian cavity of a patient. The torque generation component can be configured to generate torque and provide the generated torque to a surgical cutting assembly removably insertable within the endoscope that is configured, designed or otherwise constructed to be used with such endoscopes.FIGS. 52A-53C and54A-54B and their corresponding description provided herein relate to endoscopes including an integrated torque generation component, whileFIGS. 53D-53F and their corresponding description provided herein relate to a surgical cutting assembly insertable within the endoscope shown inFIG. 53A. Other aspects of the present disclosure relate to endoscopes configured to include a torque delivery component formed within the insertable portion of the endoscope that is configured to deliver torque to a surgical cutting assembly removable insertable within the endoscope.FIGS. 55A-55B and their corresponding description provided herein relate to endoscopes including an integrated torque delivery component. Further, aspects of the present disclosure are related to endoscopes that include either a torque generation component or a torque delivery component and are configured to convert rotational energy to linear motion to provide a surgical cutting assembly that utilizes a reciprocating motion to cut and remove tissue.FIGS. 56A-57C and their corresponding description provided herein relate to endoscopic assemblies that include an endoscope configured to convert rotational energy to linear motion to provide a surgical cutting assembly that utilizes a reciprocating motion to cut and remove tissue. Additional aspects of the present disclosure are related to endoscopic assemblies including an endoscope and a surgical cutting assembly in which the endoscope is configured to rotate an outer cannula of the surgical cutting assembly using a rotary actuator.FIGS. 58A-59B and their corresponding description provided herein relate to such endoscope assemblies. Additional aspects of the present disclosure are related to surgical cutting assemblies which include an outer coupler and an inner coupler magnetically or otherwise coupled to one another.FIGS. 60A-60B and their corresponding description provided herein relate to such surgical cutting assemblies.
• The surgical cutting assemblies described herein may be substantially similar to the endoscopic instrument or tool described with respect toFIGS. 40A and 40B. The surgical cutting assemblies described below, however, do not include a flexible torque coil that extends from outside the endoscope to the inner cannula of the surgical cutting assembly to deliver torque. Rather, the surgical cutting assemblies can include a coupling member connected to the inner cannula or cutting assembly and is configured to couple to a coupling component of the endoscope itself. The coupling component of the endoscope is configured to provide the torque to the coupling member of the surgical cutting assembly from a torque generation component integrated within the endoscope or from a torque delivery component, such as flexible torque coil as described above with respect toFIGS. 40A and 40B, that is included in the endoscope but is not part of the surgical cutting assembly.
• As previously described with respect toFIG. 14,FIG. 14 shows an implementation of animproved endoscope1400 including a built inpolyp removal assembly1440. Theimproved endoscope1400 may be configured to include a torque generation component, such as a rotary actuator configured to drive a removable surgical cutting assembly.
• FIG. 51 is perspective view of an endoscope including an integrated torque generation component or a torque delivery component according to embodiments of the present disclosure. The endoscope5100 can be sized and shaped to fit within one or more mammalian cavities of a patient. In some implementations, the endoscope5100 can be sized and shaped to fit within a particular mammalian cavity of the patient. For example, the endoscope5100 is a flexible endoscope insertable within a colon of a patient. However, the present disclosure is not limited to colonoscopes. As such, the endoscope may be a laryngoscope, a bronchoscope, a lower GI scope, a hysteroscope, among others. In some implementations, the endoscope can be a flexible endoscope that is capable of navigating a tortuous path defined by the mammalian cavity of the patient within which the endoscope is being inserted.
• The endoscope5100 can include adistal end5110 and a proximal end5114. Thedistal end5110 of the endoscope5100 includes adistal tip5112 that is first inserted within the mammalian cavity of the patient when the endoscope5100 is being inserted into the patient. The proximal end5114 can be sized to not be inserted within the mammalian cavity of the patient. Thedistal end5110 can be connected to the proximal end5114 via an elongatedtubular body5016. The elongated tubular body can be flexible such that both the distal end and a portion of the elongatedtubular body5016 is insertable within a mammalian cavity, such as a colon or other cavity that forms a tortuous path, of the patient. In some implementations, the endoscope5100 may have dimensions that are similar to existing colonoscopes. In some implementations, the proximal end5114 may be coupled to or otherwise positioned closer to a handle5120 or other component by which a medical professional or user of the endoscope can control the endoscope and one or more features of the endoscope. In some implementations, the endoscope can include one or more steering controls5122 to steer thedistal tip5112 of the endoscope5100. In addition, the endoscope5100 can include a connection housing and one or more ports, sockets, plugs or other connection mechanisms for providing one or more functionality to the endoscope, including but not limited to irrigation fluid, camera capabilities, one or more lighting components, among others.
• Referring now toFIG. 52A is a top view of the distal end of anendoscopic assembly5199 including the endoscope5100 shown inFIG. 51 and a surgical cutting assembly5220 inserted within an instrument channel5140 of the endoscope5100 is shown. Thedistal tip5112 of the endoscope5100 includes acamera5130, twolight sources5132 and5134, one ormore irrigation channels5136 and the instrument channel5140. In some implementations, the endoscope5100 can include more than one instrument channel.
• FIG. 52B is a cross-sectional view of a portion of the endoscopic assembly along the reference line B-B shown inFIG. 52A. Theendoscopic assembly5199 includes the endoscope5100 and the surgical cutting assembly5220. Additional details of thesurgical cutting assembly5320 are provided below with respect to at leastFIGS. 53A-53F. The elongatedtubular body5116 and thedistal tip5112 of thedistal end5110 of the endoscope5100 define a portion of the instrument channel5140 through which one or more instruments, such as the surgical cutting assembly, can be inserted via the proximal end of the endoscope5100. The instrument channel5140 can be a bore defined within the endoscope and extending between a first opening defined in thedistal tip5112 of the endoscope5100 and a second opening defined at the proximal end5114 of the endoscope. The instrument channel5140 extends along the length of thetubular body5116 of the endoscope5100. In some implementations, the instrument channel5140 can be cylindrical and can have a diameter that is sized to be large enough to receive a surgical cutting assembly, but small enough to be defined within the endoscope5100 while providing sufficient space within the endoscope to include other components and channels, such as the camera, light source, irrigation channels, among others. In addition, the instrument channel5140 may be sized to also provide sufficient space for a torque generation component or a torque delivery component to be inserted within or formed within the endoscope5100 as will be described in further detail below.
• In some implementations, the instruments can be inserted via thedistal end5110 of the endoscope but can only be done so before the endoscope5100 is inserted within the mammalian cavity of the patient as an opening of the instrument channel at the distal end is no longer accessible once the endoscope is inserted in the mammalian cavity.
• The endoscope5100 can include acoupling component5150. The coupling component can be positioned at or near the distal end of the endoscope5100. In some implementations, the coupling component can be positioned at thedistal tip5112 of the endoscope5100.
• In some implementations, thecoupling component5150 can be configured to be positioned around a portion of the instrument channel. Thecoupling component5150 can be configured to define a bore through which a portion of the instrument channel is defined. The diameter of the bore defined by an inner wall of the coupling component can be greater than a diameter of the instrument channel5140. In this way, the outer diameter of the portion of the instrument channel5140 is disposed within the bore of thecoupling component5150. In some implementations, the coupling component can be cylindrical. In some implementations, the inner bore of thecoupling component5150 can be cylindrical in shape, while an outer wall of the coupling component can include one or more sides or surfaces. Thecoupling component5150 can be aligned with the instrument channel5140. That is, a longitudinal axis of the bore through which a portion of the instrument channel is defined can be parallel to a corresponding longitudinal axis of the instrument channel. Moreover, each of the longitudinal axes corresponding to the coupling component, the instrument channel and the endoscope, respectively can be parallel to one another.
• The instrument channel5140 of the endoscope5100 can include an engagement portion of the instrument channel. The engagement portion of the instrument channel5140 is a portion of the instrument channel where a surgical cutting assembly inserted within the endoscope is configured to engage with thecoupling component5150 of the endoscope such that the torque generated by the torque generation component or the torque delivered by the torque delivery component can be transferred, transmitted, or otherwise provided to the surgical cutting assembly. In some implementations, the engagement portion of the instrument channel can be positioned, located or otherwise defined near the distal tip of the endoscope. In some implementations, the engagement portion of the instrument channel can be positioned, located or otherwise defined near the distal tip of the endoscope such that a component of the surgical cutting assembly configured to engage with the engagement portion of the instrument channel is able to cause a rigid cutter of the surgical cutting assembly to cut tissue. Conversely, if the engagement portion of the instrument channel is positioned away from the distal end of the endoscope such that one or more bends are formed between the engagement portion and the distal tip, the surgical cutting assembly may be designed to include a flexible torque delivery component configured to provide torque to the cutter to cut tissue. Although the description provided herein refers to torque and providing torque to the surgical cutting assembly, the torque is particularly pertinent to surgical cutting assemblies that utilize rotational motion to cut tissue. The description, however, is not limited to rotational motion based cutting assemblies and the teachings provided herein can be applied to reciprocating motion based cutting assemblies. Details of reciprocating motion based cutting assemblies are provided below.
• In some implementations, thecoupling component5150 of the endoscope5100 can be a cylindrical ring structure that includes an inner wall and an outer wall. The coupling component can be positioned around the engagement portion of the instrument channel such that the inner wall of the coupling component forms a portion of the wall of the endoscope5100 that defines the instrument channel5140.
• In some implementations, thecoupling component5150 can be sized and positioned such that the coupling component allows the endoscope to pass through a tortuous path of the mammalian cavity of the patient within which the endoscope was designed to be inserted. In some implementations, the dimensions of the coupling component can be based on a bending radius of the endoscope. In some implementations, the dimensions of the coupling component, in particular the height of the coupling component may be sized to allow the endoscope to be inserted within a mammalian cavity of the patient and to navigate a tortuous path defined by the mammalian cavity. If the height of the coupling component is too large, thecoupling component5150 may prevent the elongated tubular body within which thecoupling component5150 is formed, disposed or otherwise positioned to navigate past bends defined by the mammalian cavity. In some implementations, thecoupling component5150 may be made from a material that takes the shape of the elongated tubular body. In some such implementations, the coupling component can have a height that is greater than a height that would otherwise prevent the elongated tubular body from navigating past bends of the mammalian cavity.
• Thecoupling component5150 can be configured to provide torque from the endoscope5100 to the surgical cutting assembly5220 by coupling with a corresponding component of the surgical cutting assembly5220. Thecoupling component5150 can receive the torque to provide to the surgical cutting assembly5220 from a torque generation component, such as a rotary actuator, or from a torque delivery component, such as a torque coil or torque rope configured to deliver torque from a torque generation component to which the torque delivery component is coupled. Additional details of the torque generation component or torque delivery component from which the coupling component is configured to receive torque are provided below.
• In some implementations, thecoupling component5150 is or can include a magnetic coupler. Thecoupling component5150 can be a magnet that has a magnetic field. In some implementations, thecoupling component5150 can be positioned such that a force of the magnetic field is sufficiently strong to magnetically couple with a coupling member of thesurgical cutting assembly5320 configured to be inserted within the instrument channel of the endoscope. Thecoupling component5150 can be configured to magnetically couple with the coupling member of thesurgical cutting assembly5320 such that when thecoupling component5150 is rotated, the coupling member of thesurgical cutting assembly5320 also rotates due to the magnetic field of thecoupling component5150 acting on the coupling member of thesurgical cutting assembly5320.
• FIG. 53A is a perspective view of the portion of the endoscopic assembly shown inFIG. 51.FIG. 53B is a cross-sectional view of the portion of the endoscopic assembly shown inFIG. 53A.FIG. 53C is an enlarged cross-sectional view of the portion of the endoscopic assembly shown inFIG. 53A. Referring now toFIGS. 53A-53C as well asFIG. 52B, thesurgical cutting assembly5320 is disposed within the instrument channel5140 of the endoscope5100.
• Thesurgical cutting assembly5320 is configured to be inserted within the instrument channel5140 of the endoscope5100. As such, thesurgical cutting assembly5320 can be sized and shaped to correspond to the dimensions of the instrument channel5140. Thesurgical cutting assembly5320 can have an outer diameter or dimension that is smaller than an inner diameter or other corresponding dimension of the instrument channel. Further, in some implementations, thesurgical cutting assembly5320 may have a length that is longer than a corresponding length of the instrument channel, which may be the length between the opening of the instrument channel at thedistal tip5112 of the endoscope5100 and the opening of the instrument channel5140 at the proximal end5114 of the endoscope5100.
• FIG. 53D is a perspective view of a surgical cutting assembly inserted in the endoscope shown inFIG. 53A.FIG. 53E is a cross-sectional view of a portion of the surgical cutting assembly shown inFIG. 53D.FIG. 53F is a side cross-sectional view of the surgical cutting assembly shown inFIG. 53D. Referring now also toFIG. 53D-53F, thesurgical cutting assembly5320 can include a cutter section including anouter cannula5322 and aninner cannula5330 at a distal end of thesurgical cutting assembly5320, acoupling member5336 and an elongated flexible tubing portion (shown as including thebraided tubing5325 and anaspiration tube5331 described below) extending from the cutter section to the proximal end of thesurgical cutting assembly5320. Theouter cannula5322 can include adistal tip5323aand can define anopening5324 along a radial wall of thedistal tip5323aof theouter cannula5322. Theinner cannula5330 can be disposed within theouter cannula5322 such that theinner cannula5330 can rotate about or translate along a longitudinal axis extending through a length of thesurgical cutting assembly5320 within theouter cannula5322. Theinner cannula5330 can include a cutting edge at adistal tip5331aof theinner cannula5330 that is configured to cut tissue entering theopening5324 of theouter cannula5322. Theouter cannula5322 can have an outer diameter that is smaller than the diameter of the instrument channel5140 and theinner cannula5330 can have an outer diameter that is smaller than the inner diameter of theouter cannula5322. A gap5399 between the inner wall of theouter cannula5322 and the outer wall of theinner cannula5330 can define a portion of an irrigation channel of thesurgical cutting assembly5320.
• Aproximal end5323bof theouter cannula5322 can be coupled to anelongated braided tubing5325. Thebraided tubing5325 can extend from theouter cannula5322 to the proximal end of thesurgical cutting assembly5320. Thebraided tubing5325 can be configured to allow rotation provided at a portion of the proximal end of theelongated braided tubing5325 to be transmitted to theouter cannula5322. In this way, by rotating the portion of theelongated braided tubing5325 at the proximal end, theopening5324 of theouter cannula5322 can be rotated relative to the endoscope5100 within which thesurgical cutting assembly5320 is inserted. The inner wall of thebraided tubing5325 may also define another portion of the irrigation channel that is fluidly coupled to the gap5399 extending between theouter cannula5322 and theinner cannula5330.
• Aproximal end5331bof theinner cannula5330 can be configured to be coupled to adistal end5341aof acoupling member5340. Thecoupling member5340 may be coupled to the inner cannula such that when thecoupling member5340 rotates, theinner cannula5130 also rotates. Moreover, the bore of theinner cannula5130 defines a portion of anaspiration channel5332 through which tissue cut by theinner cannula5330 can be aspirated through the surgical cutting assembly5120. Thecoupling member5340 can be configured to define a bore that is fluidly coupled to the portion of theaspiration channel5332 defined by theinner cannula5330 such that material entering theaspiration channel5332 via a cutting tip of theinner cannula5330 is allowed to flow through thecoupling member5340. Aproximal end5341bof thecoupling member5340 may be fluidly coupled to anaspiration tube5333. Theaspiration tube5333 can be an elongated tube that may extend from theproximal end5341aof thecoupling member5340 to the proximal end of thesurgical cutting assembly5320. Theaspiration tube5333 may be disposed within theelongated braided tubing5325 and an outer wall of theaspiration tube5333, together with the inner wall of theelongated braided tubing5325 may define a portion of theirrigation channel5327. In some implementations, theaspiration tube5333 and thebraided tubing5325 may be made from a material that is configured to bend sufficiently to pass through tortuous paths defined by the instrument channel5140 once the endoscope5100 is inserted within a mammalian cavity of the patient.
• Thesurgical cutting assembly5320 can include arotary seal5336 that is configured to couple theproximal end5341aof thecoupling member5340 to adistal end5334aof theaspiration tube5333. Therotary seal5336 can be designed and configured such that therotary seal5336 prevents theaspiration tube5333 from rotating when thecoupling member5340 is rotated. In some implementations, therotary seal5336 may also be configured to couple theinner cannula5330,coupling member5340 and theaspiration tube5333 to thebraided tubing5325 andouter cannula5322. In some implementations, an outer ring of therotary seal5336 can connect theproximal end5323bof theouter cannula5322 to the distal end of thebraided tubing5325. In some implementations, an outer surface of the outer ring of therotary seal5336 can include frictional elements to allow the outer ring to frictionally engage with a portion of the outer cannula or inner wall of the braided tubing such that the outer cannula and the inner cannula can move laterally together without be rotationally coupled. Therotary seal5336 can also include an inner ring connected to the outer ring. In some implementations, the inner ring can rotate independently of the outer ring and vice versa. The inner ring may have a rotational portion and a stationary portion. The rotational portion may be coupled to theproximal end5341bof thecoupling member5340, while the stationary portion may be coupled to thedistal end5334aof theaspiration tube5333. The rotational portion and the stationary portion may be fluidly coupled such that fluid passing through theinner cannula5330 and thecoupling member5340 can flow through theaspiration tube5333. The outer ring and the inner ring may be fluidly disconnected or uncoupled such that fluid passing in theaspiration channel5332 cannot flow into the irrigation channel via therotary seal5336 and fluid from theirrigation channel5327 cannot flow into theaspiration channel5332 via therotary seal5336. Although rotary seals are described herein to couple the coupling member to the aspiration tube, any component capable of isolating rotation of the coupling member from the aspiration tube, while allowing the coupling member to be fluidly coupled to the aspiration tube may be used. Additional details as well as other aspects of the surgical cutting assembly are provided below.
• In some implementations, the surgical cutting assembly may be similar to theendoscopic tool4000 described above in that both the surgical cutting assembly and the endoscopic tool can include an outer cannula, an inner cannula, an outer braided tubing coupled to the outer cannula, an irrigation channel defined between the inner walls of the outer cannula and outer braided tubing and the outer walls of the inner cannula and the aspiration tube (defined in the endoscopic tool by the flexible torque coil). The surgical cutting assembly is different in that it does not include the flexible torque coil or rope, but rather includes a flexible aspiration tube that is coupled to the inner cannula via a coupling member capable of being magnetically coupled to a coupling component of the endoscope.
• The surgical cutting assembly can include a rotational coupler (similar to the rotational coupler4030) configured to be coupled to a proximal end of theouter braided tubing5325. The rotational coupler may be configured to allow an operator of the surgical cutting assembly to rotate theouter braided tubing5325 via a rotational tab (similar to the rotational tab4032) coupled to or being an integral part of the rotational coupler. By rotating the rotational tab, the operator can rotate theouter braided tubing5325 and theouter cannula5322 along a longitudinal axis of the endoscope and relative to the endoscope and theinner cannula5330 of thesurgical cutting assembly5320. In some implementations, the operator may want to rotate the outer cannula while the endoscopic instrument is inserted within the endoscope while the endoscope is within the patient. The operator may desire to rotate the outer cannula to position the opening of the outer cannula to a position where the portion of the radial wall of the outer cannula within which the opening or cutting window is defined may be aligned with the camera of the endoscope such that the operator can view the material entering the endoscopic instrument for resection via the opening. This is possible in part because the opening is defined along a radial wall extending on a side of the outer cannula as opposed to an opening formed on the axial wall of the outer cannula.
• In some implementations, a proximal end (similar to the proximal end4034) of the rotational coupler can be coupled to a lavage connector (similar to the lavage connector4040). In some implementations, the rotational coupler can be a rotating luer component that allows a distal end of the rotational coupler to rotate relative to the proximal end of the rotational coupler. In this way, when theouter braided tubing5325 is rotated, the component to which the proximal end of the rotational coupler is coupled, is not caused to rotate. In some implementations, the proximal end of the rotational coupler can be coupled to an outer tubular member (similar to the outer tubular member4044) configured to couple the proximal end of the rotational coupler to the lavage connector. The rotational coupler can define a bore along a central portion of the rotational coupler through which a portion of theaspiration tube5331 extends. In some implementations, the rotational coupler can be a male to male rotating luer connector. In some implementations, the rotational coupler can be configured to handle pressures up to 1200 psi.
• The lavage connector (similar to the lavage connector4040) can be configured to introduce irrigation fluid into thesurgical cutting assembly5320. The lavage connector includes a lavage port (similar to the lavage port4042) configured to engage with an irrigation source, such as a water container. In some implementations, the lavage connector can be a Y port used in fluid delivery systems that complies with medical device industry standards and is sized to couple to theouter braided tubing5325 or the outer tubular member that serves to couple a distal end of the lavage connector to the proximal end of the rotational coupler. In some implementations, the lavage connector can define a hollow channel between the proximal end and the distal end of the lavage connector that is sized to allow theaspiration tube5331 to pass through the hollow channel defined through the lavage connector.
• FIG. 54A is a cross-sectional perspective view of a portion of an endoscopic assembly including an endoscope and a surgical cutting assembly in which an endoscope includes an integrated torque generation component according to embodiments of the present disclosure. Theendoscopic assembly5499 shown inFIG. 54A can be the endoscopic assembly5100 shown inFIGS. 51-53A.FIG. 54B is an enlarged view of the torque generation component of the endoscope shown inFIG. 54A. Referring now toFIGS. 54A-54B, the endoscopic assembly includes anendoscope5400 and thesurgical cutting assembly5320 shown inFIGS. 53A-53F. Theendoscope5400 includes adistal tip5412 coupled to a distal portion of a flexible elongatedtubular body5416. The elongatedtubular body5416 can include atorque generation component5420 configured to generate torque that can be provided to thesurgical cutting assembly5320 insertable within theinstrument channel5440 of theendoscope5400 via acoupling component5450.
• In some implementations, thetorque generation component5420 can be a rotary actuator configured to generate torque or rotational energy. In some implementations, thetorque generation component5420 can be a hydraulic or pneumatic rotary actuator. In some implementations, the hydraulic or pneumatic rotary actuator can include a rotor configured to rotate by supplying a fluid to the rotary actuator. In some implementations, the rotary actuator can be actuated using a vacuum source. The rotary actuator can be sized to fit within the elongated tubular body. Moreover, the rotary actuator can be sized to fit within the elongated tubular body while allowing the elongated tubular body to navigate bends in the mammalian cavity of the patient. In some implementations, the rotary actuator can be configured to include thecoupling component5450. In some such implementations, thecoupling component5450 may form a portion of the torque generation component. In some implementations, thecoupling component5150 shown inFIGS. 53A-53C may form an inner portion of therotary actuator5420 that is configured to rotate. In some implementations, thecoupling component5450 may be coupled to a shaft of the rotary actuator such that when the shaft of the rotary actuator is rotated, thecoupling component5450 also rotates. An example of hydraulic or pneumatic rotary actuators that can be used as the torque generation component can include the vane type rotary actuators provided by Kuroda Pneumatics, Ltd. Of Tokyo, Japan. Therotary actuator5420 may include one or more features that are similar to the features of therotor440 described inFIG. 4A. As described with respect toFIG. 4A, therotor440 was formed within the endoscopic instrument insertable within an endoscope. In contrast, however, therotary actuator5420 is configured to be formed within the endoscope itself and configured to generate torque to provide to an endoscopic instrument, such as thesurgical cutting assembly5320, that does not include a torque generation component but rather receives the torque generated by therotary actuator5420 via thecoupling component5150.
• In some implementations, the elongatedtubular body5416 can include at least onefluid delivery channel5452 configured to deliver fluid to thetorque generation component5420 and at least onefluid removal channel5454 configured to remove the fluid from thetorque generation component5420. Thefluid delivery channels5452 and thefluid removal channels5452 can be defined within the elongated tubular body and may extend parallel to one another as well as one or more other channels defined within theendoscope5400. In some implementations, thefluid delivery channels5452 and thefluid removal channels5454 can be defined within the elongatedtubular body5416 such that thefluid delivery channels5452 and thefluid removal channels5454 do not intersect other channels defined within the elongatedtubular body5416. In some implementations, each of thefluid delivery channels5452 and thefluid removal channels5452 may include a corresponding opening defined at the proximal end of the elongatedtubular body5416. Thefluid delivery channels5452 can be fluidly coupled to a fluid source configured to provide a fluid to drive thetorque generation component5420. In some such implementations, thefluid removal channels5454 can be configured to remove the fluid from thetorque generation component5420 supplied by thefluid delivery channels5452. In some implementations, the fluid can be a liquid, such as water or other fluid suitable for use in driving a hydraulic rotary actuator. In some implementations, thefluid delivery channels5452 can be configured to supply pressurized air to a pneumatic rotary actuator to drive the pneumatic rotary actuator. In some such implementations, thefluid removal channels5454 can be configured to remove the air from the pneumatic rotary actuator previously supplied by the fluid delivery channels.
• In some implementations, thetorque generation component5420 can be a piezoelectric rotary actuator configured to generate torque. In some implementations, the torque generation component can be an electric motor, including but not limited to stepper motors, servo motors, among others. In some such implementations, one or more channels for electrical wires to power the electric motor may be defined within the elongated tubular body. In some implementations, the electric motor may be battery powered such that the elongated tubular body may include one or more energy storage components, such as cells, batteries or other components capable of storing electrical charge. In some such implementations, the endoscope may include a battery charging port or be constructed such that the energy storage components are removable from the endoscope. An example of motors that can be used as the torque generation component can include DC motors manufactured by Maxon Precision Motors, Inc., of Fall River, Mass., USA. These DC motors can have sizes that can range from less than 4 mm to greater than 12 mm. As the elongated tubular bodies of typical colonoscopes can have an outer diameter of about 13 mm, these motors can be integrated within the elongated tubular bodies, while still providing space to provide channels of other features. In some implementations, the SQUIGGLE micromotor and M3-R motors manufactured by New Scale Technologies of Victor, N.Y., USA may also be used. In some implementations, the SQUIGGLE micromotor can be used to generate linear motion, which is described above with respect toFIGS. 56-57C.
• In some implementations, thecoupling component5450 can form a portion of the torque generation component. The torque generation component can be a frameless motor that includes a stator and a rotor. In some implementations, thecoupling component5450 can form the stator portion of the frameless rotor. Thecoupling component5450 can be sized to fit within the endoscope and positioned such that thecoupling component5450 surrounds a portion of the instrument channel towards the distal tip of the endoscope. Thecoupling component5450 can be configured to engage with thecoupling member5340 of thesurgical cutting assembly5320 such that thecoupling member5340 rotates when thecoupling component5450 is actuated. The coupling component may be actuated by an electric current, which can be provided via an electrical connection to a power source. In some implementations, the electrical connection can be from a power source outside the endoscope. In some implementations, the electrical connection can be from a battery or other power source disposed within the endoscope.
• In some implementations, the elongatedtubular body5416 of theendoscope5400 may define a cavity positioned near the distal tip of theendoscope5400. The cavity may be sized and shaped to contain the torque generation component. The cavity may include openings that are fluidly coupled to thefluid delivery channels5452 and thefluid removal channels5454. The torque generation component can be positioned such that the openings of thefluid delivery channels5452 and thefluid removal channels5454 are fluidly coupled to the torque generation component to cause thetorque generation component5420 to generate torque upon supplying and removing the fluid to thetorque generation component5420.
• Thetorque generation component5420 or the cavity within which the torque generation component is disposed may be sized such that the endoscope is capable of passing through tortuous paths defined by a mammalian cavity of a patient within which the endoscope is configured to be inserted. Moreover, the torque generation component may be disposed in the endoscope at a location that is close to the distal tip such that thecoupling component5450 that is part of or coupled to the torque generation component can provide the torque generated by thetorque generation component5420 to the surgical cutting assembly such that a distal end of the inner cannula of the surgical cutting assembly can extend beyond thedistal tip5412 of theendoscope5400, while a proximal end of theinner cannula5330 is rotationally coupled to thecoupling component5450 of theendoscope5400 and the surgical cutting assembly does not include a torque delivery component that may be configured to deliver the torque generated by thetorque generation component5420.
• FIG. 55A is a perspective view of a portion of an endoscopic assembly including an endoscope and a surgical cutting assembly in which the endoscope includes an integrated torque delivery component according to embodiments of the present disclosure.FIG. 55B is a cross-sectional perspective view of the portion of the endoscope shown inFIG. 55A and a surgical cutting assembly inserted in the endoscope according to embodiments of the present disclosure. Referring now toFIGS. 55A and 55B, theendoscopic assembly5599 includes anendoscope5500 and a surgical cutting assembly, such as thesurgical cutting assembly5320. Theendoscope5500 is similar to theendoscope5400 but different in that theendoscope5500 does not include atorque generation component5400, but instead, includes atorque delivery component5560 that is coupled to acoupling component5550 that is configured to provide the torque from the torque delivery component to thesurgical cutting assembly5320.
• Thetorque delivery component5560 can be a flexible torque coil or torque rope capable of delivering torque applied at a proximal end of the torque delivery component that extends outside a proximal end of theendoscope5500 to a distal end of the torque delivery component disposed within theendoscope5500. The torque delivery component can be similar to theflexible cable1920 described above toFIGS. 19A-19C and thetorque coil4080 described above with respect toFIG. 40. Thetorque delivery component5560 can include a plurality of layers of threads. Each layer of threads can be wound in a direction opposite to a direction in which an adjacent layer of threads is wound. Thetorque delivery component5560 can be configured to provide rotation in a first direction based on the way the layers of threads are wound. In some implementations, thetorque delivery component5560 may be designed to deliver rotational energy in a preferred direction but may be capable of delivering rotational energy in a direction opposite the preferred direction. Although thetorque delivery component5560 can similar to theflexible cable1920 or thetorque coil4080, thetorque delivery component5560 can be any type of torque delivery component capable of delivering rotational energy that is provided at a proximal end of the torque delivery component that extends outside a proximal end of theendoscope5500 to a distal end of the torque delivery component that is disposed within the elongated tubular body5516 of theendoscope5500.
• The proximal end of thetorque delivery component5560 can be configured to couple to a torque generation component configured to generate rotational energy. The torque generation component can be any rotary actuator capable of providing rotational energy to thetorque delivery component5560 to deliver to the distal end of the torque delivery component. The size and shape of thetorque delivery component5560 can be such that thetorque delivery component5560 is capable of delivering sufficient rotational energy to cause theinner cannula5330 of thesurgical cutting assembly5320 insertable within theendoscope5500 to rotate at a sufficient speed to cut tissue from a surgical site within the mammalian cavity of the patient.
• Theendoscope5500 includes atorque delivery channel5558 configured to dispose the torque delivery component. The torque delivery channel can be sized to have an inner diameter that is slightly larger than an outer diameter of the torque delivery component. In some implementations, thetorque delivery channel5558 can be lined with a heat-absorbing material or other such material, such as PTFE, that absorbs heat generated by thetorque delivery component5560 when thetorque delivery component5560 is operating. The torque delivery channel can extend from the distal end of the endoscope to an opening defined at the proximal end of the endoscope. The torque delivery channel can have a longitudinal axis that extends parallel to a longitudinal axis of the instrument channel5540. In some implementations, thetorque delivery channel5558 may be defined within the endoscope such that the torque delivery channel does not intersect or otherwise interfere with any other components in the endoscope. The distal end of the torque delivery channel can include an opening that is configured to allow the distal end of thetorque delivery component5558 to couple to atorque transferring assembly5564.
• Thetorque transferring assembly5564 can include thecoupling component5550 and asecond coupler5566. In some implementations, the distal end of thetorque delivery component5560 can be coupled to thesecond coupler5566, such that torque from thetorque delivery component5560 is transferred to thesecond coupler5566, causing thesecond coupler5566 to rotate. In some implementations, thetorque delivery component5560 can be coupled to thesecond coupler5566 with a friction based fit, such as a press fit or using some adhesive or other coupling mechanism. In some implementations, the outer wall of thetorque delivery component5560 is attached to aninner wall5568 of thesecond coupler5566. In some implementations, thecoupling component5550 and thesecond coupler5566 can be cylindrical ring structures. In some implementations, the outer portions of the radial wall of thecoupling component5550 and theradial wall5569 of thesecond coupler5566 may include grooves, raised edges, or other engagement members configured to provide rotational energy from thesecond coupler5566 to thecoupling component5550 and from thecoupling component5550 to thesecond coupler5566. In this way, torque from thetorque delivery component5560 can cause thesecond coupler5566 to rotate, which in turn, can cause thecoupling component5500 to rotate, which in turn can cause theinner cannula5330 of thesurgical cutting assembly5320 disposed within the instrument channel5540 of theendoscope5500 to rotate.
• Thesurgical cutting assembly5320 includes the outer cannula5522, theinner cannula5530, acoupling member5340 coupled to theinner cannula5330, anaspiration tube5331 coupled to a proximal end of the coupling member and abraided tubing5325 that is coupled to aproximal end5323bof theouter cannula5322 and within which the aspiration tube5531 and thecoupling member5340 are disposed. In some implementations, theinner cannula5530 can have a length that is greater than the outer cannula5522 such that a portion of theinner cannula5530, thecoupling member5340 and theaspiration tubing5331 are disposed within thebraided tubing5325 of thesurgical cutting assembly5320. This can allow thecoupling member5340 to be adjacent to but separated from thecoupling component5550 of theendoscope5500 by thebraided tubing5325 of thesurgical cutting assembly5320 instead of theouter cannula5322. In some implementations, the length of theinner cannula5330 and thecoupling member5340 may be greater than the length of theouter cannula5322 to ensure that a portion of thecoupling member5340 is separated from thecoupling member5550 by the braided tubing5525.
• In operation, when thetorque delivery component5560 is actuated by a torque generation component, thetorque delivery component5560 can receive the torque generated by the torque generation component at the proximal end of thetorque generation component5560 and translate that torque to the distal end of thetorque delivery component5560. Thetorque delivery component5560 is rotationally coupled to thesecond coupler5566 such that the torque from thetorque delivery component5560 is transferred to thesecond coupler5566. Thesecond coupler5566 can be rotationally coupled to thecoupling component5550, which can be positioned around a portion of the instrument channel of the endoscope. The torque of thesecond coupler5566 can be transferred to thecoupling component5500. The coupling component can rotate creating a magnetic field due to the coupling component including magnets in an inner portion of the coupling component. The inner portion of thecoupling component5550 can surround a portion of the instrument channel and be positioned such that the coupling component rotates along a longitudinal axis that extends substantially parallel to an axis of the portion of the instrument channel of the endoscope adjacent to thecoupling component5550. When the surgical cutting assembly is inserted within the instrument channel, the surgical cutting assembly can be inserted far enough in the instrument channel such that the distal tip of the outer cannula is extending outside the distal tip of the endoscope and the coupling member attached to the inner cannula is disposed within the portion of the instrument channel is that adjacent to thecoupling component5550. The coupling member attached to the inner cannula can be made from or include a material on an outer radial wall of the coupling member that is capable of being influenced by the magnetic field of the coupling component. In some implementations, the coupling member can be made from a ferromagnetic material capable of being magnetized, such as a metal or metal alloy, for example, annealed iron. When thecoupling member5340 of the surgical assembly is positioned adjacent to thecoupling component5550, a magnetic coupling effect takes place such that the coupling component and thecoupling member5340 are magnetically coupled. As described above, during operation, when the coupling component is rotated due to the torque being transferred via the torque delivery component, the rotation of the coupling component rotates the coupling member, which thereby causes the inner cannula to rotate.
• The lengths of the outer cannula, the inner cannula and the coupling member of the surgical cutting assembly, the length of the coupling component and the position of the coupling component relative to the opening of the instrument channel at the distal tip of the endoscope are features that can affect the operability and performance of the endoscopic assembly. One constraint when selecting a length of the coupling component is the bend radii of the endoscope. The coupling component may be sized to have a length that does not prevent the endoscope from having a bend radii that is greater than a threshold amount. The threshold amount may be specific to the type of endoscope. For instance, a colonoscope may have a bend radii that is less than a hysteroscope as the bends formed by the colon as much sharper than bends in the uterine canal of patients. In some implementations, the colonoscope can be configured to bend about 180 degrees in the vertical (y) axis and about 160 degrees in the horizontal (x) axis. The colonoscope can be configured to make bend angles that are less than 180 degrees in the y axis and less than 160 degrees in the x axis but this may adversely affect the endoscope's ability to traverse through the tortuous path defined by the colon, especially at the junction connecting the sigmoid to the rectum. As such, the length of the coupling component should be sized such that the colonoscope is capable of bending at least the threshold amount along the vertical and horizontal axes. Further, the length of the outer cannula and the combined length of the inner cannula and coupling member should be sufficiently small that the surgical cutting assembly is insertable within the endoscope while the endoscope is inserted within the mammalian cavity of the patient. The length of the inner cannula and coupling member, however, should be large enough that the coupling member is positioned adjacent to the coupling component of the endoscope to allow the coupling member to magnetically couple to the coupling component.
• FIG. 56A is a perspective view of a portion of an endoscopic assembly including an endoscope having an integrated torque generation assembly capable of causing a surgical cutting assembly inserted within the endoscope to cut tissue in a reciprocating motion according to embodiments of the present disclosure.FIG. 56B is an enlarged perspective view of the torque generation assembly shown inFIG. 56A. Theendoscopic assembly5699 includes anendoscope5600 and thesurgical cutting assembly5320. The endoscope is similar to the other endoscopes, such as theendoscope5500 but differs in that the endoscope includes a linear motion generation assembly that includes arotary actuator5610, a rotary to linearmotion converting assembly5620 configured to convert rotational motion to linear motion, and acoupling component5650 having an outer surface configured to engage with the rotary to linearmotion converting assembly5620. Therotary actuator5610 can be a hydraulic or pneumatic rotary actuator or an electric rotary actuator, similar to ones described herein. In some implementations, the rotary actuator includes a shaft that is coupled to the rotary to linearmotion converting assembly5620.
• The rotary to linearmotion converting assembly5620 can include afirst gear5622 coupled to the shaft of therotary actuator5610. Thefirst gear5622 can include engagement elements configured to engage with corresponding engagement elements of asecond gear5624. The orientation of the first gear is transverse to the axis of rotation of the shaft of the rotary actuator. The orientation of thesecond gear5624 is transverse to the orientation of the first gear such that agear coupler5630 coupled to thesecond gear5624 is configured to rotate along an axis that is transverse to a longitudinal axis of the coupling component and the instrument channel around which the coupling component is positioned. Thegear coupler5630 can include one ormore structures5632 on an outer wall of thegear coupler5630 that are configured to engage withcorresponding structures5652 formed on an outer wall of thecomponent coupler5650. Thestructures5632 are configured to frictionally engage with thestructures5652 such that when thegear coupler5630 rotates, thestructures5632 and thestructures5652 engage with one another to cause the coupling component to move along the longitudinal axis extending through the length of the instrument channel and thecoupling component5650. The direction in which therotary actuator5610 rotates dictates the direction in which thecoupling component5650 moves along the longitudinal axis. In some implementations, the rotary actuator is configured to rotate in a first direction to cause the coupling component to move from a first position to a second position and then rotate in a second direction opposite to the first direction to cause the coupling component to move from the second position back the first position. In some implementations, the rotary to linearmotion converting assembly5620 may also include asupport structure5612 configured to keep therotary actuator5610 and the first andsecond gears5622 and5624 in place.
• It should be appreciated that the rotary to linearmotion converting assembly5620 shown inFIG. 56A is one implementation of a rotary to linear motion converting assembly. The rotary to linearmotion converting assembly5620 can include any number of components that collectively are configured to convert rotary motion generated by a rotary actuator to linear motion that can cause the coupling component of the endoscope to repeatedly move between a first position to a second position such that an inner cannula can cut or resect material entering a cutting window or opening of an outer cannula of a surgical cutting assembly inserted within the instrument channel of the endoscope.
• In some implementations, instead of using a rotary actuator and a rotary to linear motion converting assembly, the endoscope can include an actuator configured to generate linear motion. For example, a SQUIGGLE micromotor manufactured by New Scale Technologies of Victor, N.Y., USA or the principles on which the SQUIGGLE motor works can be employed to cause the coupling component to move linearly along a longitudinal axis of the instrument channel. As the coupling member of thesurgical cutting assembly5320 can be magnetically coupled to the coupling component, as the coupling component moves linearly along the longitudinal axis, the coupling member and the inner cannula coupled thereto will move linearly along the longitudinal axis as well.
• FIGS. 57A-57C is a side perspective view of a portion of an endoscopic assembly including an endoscope and a surgical cutting assembly inserted within the endoscope to cut tissue in a reciprocating motion according to embodiments of the present disclosure.FIG. 57A shows anendoscopic assembly5799 that includes anendoscope5700 and asurgical cutting assembly5720. Thesurgical cutting assembly5720 is similar to thesurgical cutting assembly5320 but differs in that the inner cannula is configured to move linearly relative to the outer cannula in contrast with rotating along a longitudinal axis relative to the outer cannula. Various components of theendoscopic assembly5799 are not shown. InFIG. 57A, thecoupling member5740 of thesurgical cutting assembly5720 is shown to be positioned in a first position. In this position, adistal end5742 of thecoupling member5740 is positioned close to the distal tip. When thecoupling member5740 is in the first position, theinner cannula5730 of thesurgical cutting assembly5720 is in a closed position. In the closed position, a distal tip of theinner cannula5730 is either in contact with or close to the inner wall of a distal end of theouter cannula5722 such that theinner cannula5730 blocks theopening5724 of the outer cannula2722 as shown.
• InFIG. 57B, thecoupling member5740 of thesurgical cutting assembly5720 is shown to be positioned in a second position. In this position, adistal end5742 of thecoupling member5740 is positioned farther away from the distal tip when compared to when thecoupling member5740 was in the first position as shown inFIG. 57A. When thecoupling member5740 is in the second position, theinner cannula5730 of thesurgical cutting assembly5720 is in a half closed position. In the half-closed position, a distal tip of theinner cannula5730 is positioned such that theinner cannula5730 blocks a portion of theopening5724 of the outer cannula2722 as shown.
• InFIG. 57C, thecoupling member5740 of thesurgical cutting assembly5720 is shown to be positioned in a third position. In this position, adistal end5742 of thecoupling member5740 is positioned farther away from the distal tip when compared to when thecoupling member5740 was in the second position as shown inFIG. 57C. When thecoupling member5740 is in the third position, theinner cannula5730 of thesurgical cutting assembly5720 is in an open position. In the open position, a distal tip of theinner cannula5730 is positioned such that theinner cannula5730 does not block theopening5724 of the outer cannula2722 as shown.
• FIG. 58A is a perspective cross-sectional view of an endoscopic assembly including an endoscope and a surgical cutting assembly in which the endoscope is configured to rotate an outer cannula of the surgical cutting assembly using an actuator according to embodiments of the present disclosure.FIG. 58B is a perspective view of a component of the endoscope for rotating the outer cannula of the surgical cutting assembly shown inFIG. 58A. Theendoscopic assembly5899 includes anendoscope5800 and asurgical cutting assembly5820. Theendoscope5800 can be similar to any of the endoscopes shown inFIGS. 51-57 but differs in that theendoscope5800 includes anarticulation assembly5859 configured to articulate anouter cannula5822 of thesurgical cutting assembly5820 relative to a longitudinal axis of the outer cannula extending through the length of the outer cannula. Thearticulation assembly5859 is disposed within the distal end of theendoscope5800 and can include atorque generation component5860, afirst gear5862 coupled to the torque generation component and asecond gear5864 coupled to thefirst gear5862. The second gear can include an innerradial wall5876 within which one ormore engagement elements5878 are defined. Theseengagement elements5878 can include grooves or ribs that are configured to engage withcomplementary engagement elements5823 defined on theouter cannula5822. In some implementations, the complementary engagement elements can be ribs or grooves.
• Thetorque generation component5860 can be a rotary actuator configured to rotate in one or both directions. In some implementations, the rotary actuator can be an electric motor configured to generate sufficient torque to rotate theouter cannula5822. In some implementations, the rotary actuator can be controlled by a switch or other input mechanism that allows an operator of the endoscope to actuate the rotary actuator. In some implementations, therotary actuator5860 is configured to rotate theouter cannula5822 to one or more predefined positions. In some implementations, the predefined positions may be relative to a position of a camera of theendoscope5800. For example, one position may orient the cutting window or opening5824 of the outer cannula such that the camera can capture an image that shows the cutting window. In some implementations, thearticulation assembly5859 can be defined within a distal tip of theendoscope5800. In some implementations, thearticulation assembly5859 can be positioned within the endoscope such that thearticulation assembly5859 does not interfere with other components of the endoscope, including the torque generation component or torque delivery components configured to rotate thecoupling component5850 configured to rotate theinner cannula5830 of thesurgical cutting assembly5820 disposed within theendoscope5800. Thecoupling component5850 can be similar to other coupling components shown inFIGS. 51A-57B.
• It should be appreciated that to rotate theouter cannula5822 via thearticulation assembly5859, care must be taken to not rotate theouter tubing5825 that is coupled to the outer cannula and configured to define a portion of the irrigation channel as described herein. In some implementations, arotary seal5846 may couple theouter tubing5825 to theouter cannula5822. Therotary seal5846 can allow theouter cannula5822 to rotate about its longitudinal axis while preventing the outer tubing from rotating along with theouter cannula5822.
• In some implementations, theendoscope5800 can include a dedicated irrigation channel defined within theendoscope5800 that is configured to provide irrigation fluid to the surgical cutting assembly insertable within the endoscope. In some implementations, the dedicated irrigation channel can extend between an irrigation fluid entry opening defined in a proximal end of the elongated tubular body of the endoscope and an irrigation fluid exit opening defined within the body of the tubular body. The irrigation fluid exit opening can be positioned such that the irrigation fluid exit opening is capable of fluidly coupling to the surgical cutting assembly insertable within the instrument channel of the endoscope. In some implementations, the irrigation fluid exit opening can be configured to engage with an opening to an irrigation pathway defined in the surgical cutting assembly. In some implementations, the irrigation fluid exit opening can be defined in a radial wall defining the instrument channel. In some implementations, the irrigation fluid exit opening can be defined close to or within thearticulation assembly5859. In some implementations, the irrigation fluid exit opening can fluidly connect to an opening defined near or within an opening of the outer cannula such that when the outer cannula engages with thearticulation assembly5859, the irrigation fluid exit opening can be fluidly coupled to the irrigation pathway defined by the inner wall of the outer cannula and the outer wall of the inner cannula of the surgical assembly. In some implementations, the irrigation fluid from the irrigation channel defined within the endoscope can be configured to enter the surgical cutting assembly due to a suction force applied to the aspiration channel of the surgical cutting assembly. In some implementations in which the aspiration channel is fluidly coupled to the irrigation fluid exit opening, the irrigation fluid can flow from the irrigation fluid exit opening of the endoscope to an opening within the surgical cutting assembly. In some implementations, the opening within the surgical cutting assembly may be fluidly coupled to the aspiration channel, such that the suction force applied to the aspiration channel can cause the irrigation fluid to enter the opening of the surgical cutting assembly and into the aspiration channel via the cutting window of the outer cannula. The surgical cutting assembly can include the irrigation fluid opening at a location near the outer cannula. In some implementations, the irrigation fluid opening can be located at a location where the outer cannula is coupled to the outer tubing of the surgical cutting assembly.
• In some implementations, one or more seals can be positioned to prevent the fluid from escaping from the opening of the instrument channel defined at the distal end of the endoscope. In some implementations, one or more seals can further be positioned to prevent the irrigation fluid from escaping from the opening of the instrument channel defined at the proximal end of the endoscope. The irrigation channel can be configured to carry irrigation fluid to irrigate the aspiration channel of the surgical cutting assembly. In some implementations, the irrigation channel can be configured to also provide topical medication as will be described below. In some implementations, a control mechanism can control an amount of fluid being provided to the irrigation channel. The control mechanism can be controlled by an operator of the endoscope. In some implementations, the control mechanism can be an actuator.
• FIG. 59A is a perspective view of the surgical cutting assembly shown inFIG. 58A.FIG. 59B is a perspective cross-sectional view of the surgical cutting assembly shown inFIG. 58A. Thesurgical cutting assembly5820 can include anouter cannula5822, an inner cannula disposed within the outer cannula, acoupling member5840 that is coupled to the inner cannula and configured to rotate when thecoupling member5840 is positioned adjacent a rotating coupling component of the endoscope within which the surgical cutting assembly is inserted. The surgical cutting assembly can also include arotary seal5836 that is configured to fluidly couple thecoupling member5840 to anaspiration tube5831 having an inner wall that defines a portion of anaspiration channel5832. The outer cannula can include one ormore engagement elements5823 configured to engage with complementary engagement elements of the articulation assembly of theendoscope5800. Further, theouter cannula5822 can be coupled to anouter tubing5825 via a rotary seal (not shown inFIGS. 59A and 59B) that is configured to allow the outer cannula to rotate relative to theouter tubing5825. An inner wall of theouter tubing5825 and the outer wall of theaspiration tube5831 can define a first portion of an irrigation channel configured to deliver irrigation fluid to the opening of the outer cannula that defines one end of the aspiration channel. An inner wall of the outer cannula582 and an outer wall of theinner cannula5830 defines a second portion of the irrigation channel that is fluidly coupled to the first portion.
• FIG. 60A is a perspective view of a surgical cutting assembly according to embodiments of the present disclosure.FIG. 60B is a perspective cross-sectional view of the surgical cutting assembly shown inFIG. 60A. The surgical cutting assembly6020 is similar to thesurgical cutting assembly5820 shown inFIG. 59A but differs in that the surgical cutting assembly6020 includes anouter coupling component6044. The outer coupling component can have an outer diameter that is less than an inner diameter of the instrument channel of an endoscope within which the surgical cutting assembly is configured to be inserted. Moreover, theouter coupling component6040 can be configured to engage with a complementary coupling component that can provide torque to the outer coupling component.
• Theouter coupling component6044 can include a hollow bore within which other components of the surgical cutting assembly6020 can be disposed. For instance, a portion of theouter braided tubing6029 can be coupled to the outer coupling component via a rotary seal or other component that allows the outer coupling component to rotate while maintaining the braided tubing stationary relative to the outer coupling component.
• Similar to thesurgical cutting assembly5820, the outer braided tubing6025 can be coupled to anouter cannula6022, while aninner cannula6030 disposed within the outer cannula can be coupled to anaspiration tube6031 via aninner coupling member6040. Theinner coupling member6040 can be coupled to theouter coupling component6044 such that theinner coupling member6040 moves with theouter coupling component6044. Theinner coupling member6040 can be coupled to theouter coupling component6044 such that when the outer coupling component rotates, theinner coupling member6040 also rotates. In some implementations, theinner coupling member6040 can be magnetically coupled to theouter coupling component6044. To do so, the inner portion of theouter coupling component6044 may be configured to include one or more magnets to create a magnetic force on theinner coupling member6040.
• Theinner coupling member6040 can be aligned with theouter coupling component6044 such that theinner coupling member6040 is positioned adjacent to theouter coupling component6044. In some implementations, the inner coupling member and the inner cannula can be sized relative to the outer cannula and the outer coupling component such that when the distal tip of the inner cannula is adjacent the cutting window or opening of the outer cannula, the inner coupling member is adjacent to the outer coupling component but separated from the outer coupling component by the outer tubing that is coupled to the outer cannula. In some implementations, therotary seal6036 that fluidly couples the inner coupling member to the aspiration tube but maintains the inner coupling member rotationally decoupled from the aspiration tube can be configured to include an outer ring or radial surface that is As theinner coupling member6040 and theouter coupling component6044 are assembled so that they remain in alignment with one another, theinner coupling member6040 can be more responsive to rotational energy provided to theouter coupling component6044 relative to when theinner coupling member6040 is magnetically coupled to an outer coupling member that is not a part of the surgical cutting assembly6020, but rather a part of the endoscope within which the surgical cutting assembly is inserted.
• The endoscope within which the surgical cutting assembly6020 can be inserted can include the complementary coupling component from which theouter coupling component6044 is configured to receive rotational energy or torque. The complementary coupling component can be the stator of a frameless motor in which theouter coupling component6044 serves as the rotor. In some implementations, the complementary coupling component can be a rotating portion of a torque generation component or a rotating member configured to provide torque from a torque generation component or torque delivery component of the endoscope. In some implementations, the complementary coupling component can be capable of transmitting torque to the outer coupling component via friction or other physical contact. In some implementations, the complementary coupling component does not need to be positioned around the instrument channel. Instead, the complementary coupling component can be designed and positioned within the endoscope to transfer rotational energy from a torque generation component or torque delivery component to theouter coupling component6044. The complementary coupling component can be a wheel or rotary component that has an outer surface capable of contacting the outer radial wall of theouter coupling component6044.
• As described herein, the surgical cutting assemblies, such as the surgical cutting assemblies shown inFIGS. 52A-60B can include or define an irrigation channel through which irrigation fluid is provided from outside the endoscope to the distal tip of the endoscope. The irrigation fluid at the distal tip can enter the opening or cutting window defined in the outer cannula and pass through the aspiration channel defined in part by the inner wall of the inner cannula and an aspiration tube. For the irrigation fluid to enter the inner cannula via the opening defined in the outer cannula, a suction force is generally applied at the proximal end of the aspiration tube to create a pressure difference that causes the irrigation fluid to enter the aspiration channel. In some implementations, the irrigation channel can be used as a drug delivery channel. To do so, the irrigation fluid, which is generally water, can be replaced with a drug solution that is to be administered at a site, such as the surgical site, within the mammalian cavity of the patient. To prevent the drug from being suctioned into the aspiration channel when the drug solution approaches the distal tip of the outer cannula, the suction force applied to the aspiration channel may be switched off or reduced. Moreover, the pressure or flow rate at which the drug solution is delivered may be increased to a much higher rate such that the drug solution can exit from the gap defined between the inner cannula and the outer cannula with a large enough force or pressure to be squirted, sprayed or otherwise directed towards the site within the mammalian cavity at which to deliver the drug solution. In some implementations, the drug solution can exit the surgical cutting assembly in a direction based on the position of the opening of the outer cannula. As described above, the outer cannula can be rotated via an outer braided tubing that is coupled to the outer cannula at a distal end and has a proximal end that extends out of the opening of the instrument channel at the proximal end of the endoscope. In some implementations, the irrigation channel can be configured to receive the fluid at a first flow rate to provide irrigation fluid to facilitate aspiration and at a second flow rate to spray the irrigation fluid via an opening or cutting window of the outer cannula at a site within the mammalian cavity.
• As described above, the endoscope may include a dedicated irrigation channel defined within the elongated body of the endoscope. In some implementations, the surgical cutting assembly can include an irrigation fluid opening to receive irrigation fluid from the irrigation channel defined within the endoscope. In some implementations, the irrigation fluid opening can be located at a location near the outer cannula. In some implementations, the irrigation fluid opening can be located at a location where the outer cannula is coupled to the outer tubing of the surgical cutting assembly. In some implementations, the irrigation fluid can be configured to enter an irrigation pathway of the surgical cutting assembly that is partially defined by the inner wall of the outer cannula and the outer wall of the inner cannula. In some implementations, the beginning of the irrigation pathway is the irrigation fluid opening that is fluidly coupled to the irrigation fluid exit opening defined within the endoscope.
• In some implementations, the instrument channel of an endoscope can configured to include at least one groove configured to engage with a corresponding key of a surgical cutting assembly insertable within the endoscope to ensure that an orientation of an opening of an outer cannula of the surgical cutting assembly is aligned with respect to a camera lens of the endoscope. In some implementations, the proximal end of the outer tubing can include markings indicating a length of a portion of the surgical cutting assembly that has been inserted into the instrument channel as well as an orientation of the cutting window of the outer cannula. In this way, the medical professional inserting the surgical cutting assembly may rotate the proximal end of the outer tubing to position the cutting window of the outer cannula to a desired position.
• It should further be appreciated that the surgical cutting assembly can be similar to theendoscopic tool4000 previously described with respect toFIGS. 40A-49B. In some implementations, the surgical cutting assemblies described with respect toFIGS. 51-60B may differ from theendoscopic tool4000 in that the surgical cutting assemblies replace a flexible torque coil with an aspiration tube. As described herein, the aspiration tube can be fluidly coupled to a coupling member that is coupled to the inner cannula. In some implementations, a seal or other coupling component can be included in the surgical cutting assemblies that fluidly couple the coupling member to the aspiration tube but allow the coupling member to be rotationally decoupled from the aspiration tube. Further, the proximal end of the aspiration tube can be configured to be connected to a suction source without having to couple to a proximal connector that is configured to drive the flexible torque coil similar to the proximal connector described with respect toFIGS. 40A-49B.
• In some implementations, the endoscopes described with respect toFIGS. 50A-60B describe inserting the surgical cutting assembly from an opening at a proximal end of the endoscope. However, in some other implementations, a surgical cutting assembly can be configured to be inserted into the endoscope via an opening of the instrument channel at the distal end of the endoscope. In some implementations, the surgical cutting assembly may not include an aspiration tube or an outer tubing. Rather, the surgical cutting assembly may include an outer cannula, an inner cannula and a coupling member configured to move (translate or rotate, among others) the inner cannula relative to the outer cannula. In some implementations, the outer cannula can be configured to engage with an articulation assembly configured to rotate the outer cannula relative to the endoscope. The articulation assembly can be controlled or actuated by the operator of the endoscope via a control mechanism. The operator can rotate or articulate the orientation of the outer cannula and as such, the cutting window of the outer cannula. The surgical cutting assembly can be configured to engage with a deployment component of the endoscope configured to be actuated by an actuator. The deployment component can be configured to bias the surgical cutting assembly in a retracted position. In some implementations, the operator may load the surgical cutting assembly in a retracted position within the endoscope prior to inserting the endoscope in the mammalian cavity of the patient. The deployment component can be configured to maintain the surgical cutting assembly disposed within the tubular body in a undeployed or retracted position. The deployment component can further be configured to deploy the surgical cutting assembly from the undeployed position to a deployed position upon actuation of the deployment component. In some implementations, the deployment component is configured to move between a closed state in which the surgical cutting assembly is maintained in the undeployed position and an opened state in which the surgical cutting assembly is deployed to the second deployed position. In some implementations, the deployment component can be a slidable cover that covers the distal end of the endoscope. In some implementations, the deployment component can be a spring that can move between a biased state and a relaxed state.
• In some implementations, when the surgical cutting assembly is in the deployed position, the outer cannula of the surgical cutting assembly extends outwardly along a longitudinal axis of the endoscope from the distal end of the endoscope such that the cutting window can be viewed in an image captured by the camera.
• FIG. 61 shows anendoscopic assembly6199 that includes theendoscope5300 shown inFIG. 53B and asurgical cutting assembly6120 similar to the surgical cutting assembly shown inFIG. 53B. As shown inFIG. 61, the length of acoupling member6140 of thesurgical cutting assembly6120 is greater than the length of thecorresponding coupling component5350 of theendoscope5300. Although the dimensions of both thecoupling component5350 and thecoupling member6340 are constrained because both the endoscope and the surgical cutting assembly have to be sized to be insertable within a mammalian cavity of the patient, by having the length of thecoupling member6340 exceed the length of thecoupling component5350, the operator of the surgical cutting assembly may be able to move the surgical cutting assembly along the longitudinal axis of the instrument channel of the endoscope over a distance that is based on the length of thecoupling member6340. As long as a portion of thecoupling member6340 is positioned adjacent to thecoupling component5350, thecoupling member6340 can be configured to be magnetically coupled to thecoupling member5350. This can allow an operator more freedom and a larger distance of movement of the surgical cutting assembly along the longitudinal axis of the instrument channel of the endoscope while still being able to cause the inner cannula to rotate relative to the outer cannula.
• In some implementations, the coupling member of thesurgical cutting assembly6120 has a first length that extends from a first end coupled to the inner cannula to a second end coupled to the aspiration tube. In some implementations, the first length can be greater than a corresponding length of the coupling component of the endoscope within which the surgical cutting assembly is insertable. Thecoupling member6340 can be configured to rotatably couple to the coupling component of theendoscope5300 over a distance that extends from a first position where the first end of the inner cannula is adjacent to a proximal end of the coupling component to a second position where the second end of the coupling member is adjacent to a distal end of the coupling component.
• In some implementations, the coupling member of the surgical cutting assembly can have a first length extending from a first end coupled to the inner cannula and a second end coupled to the aspiration tube that is less than a corresponding length of the coupling component of the endoscope within which the surgical cutting assembly is insertable. In some such implementations, the coupling member is configured to be rotatably coupled to the coupling component over a distance that extends from a first position where the distal end of the inner cannula is adjacent to a proximal end of the coupling component to a second position where the second end of the coupling member is adjacent to a distal end of the coupling component.
• It should be appreciated that by providing an coupling member of the surgical cutting assembly that is longer than the corresponding coupling component of the endoscope, an operator of the surgical cutting assembly will have more maneuverability to perform surgical resection. As the length of the coupling member is limited by the space within which the surgical cutting assembly has to be inserted and the tortuous paths that can be taken by the endoscope when being inserted within the mammalian cavity, in some implementations, telescoping tubes or couplers may be used. A surgeon may increase the length of the coupling member or the surgical cutting assembly telescopically to allow for an increased reach. In addition, the use of telescoping tubes can provide for variable exposure giving the surgeon more control.
• Generally, the size and dimensions of the endoscope may vary based on the type of endoscope and the size and shape of the mammalian cavity of the patient within which the endoscope is to be inserted. For example, the endoscope can be a colonoscope configured to pass through the colon of a patient. The colonoscope can have an outer diameter that is sized to be insertable inside an orifice through which the colon is accessed. Moreover, the colonoscope may be pliable or flexible enough to be inserted along a length of the colon and capable of navigating through a tortuous path defined by the colon. It should be appreciated that the colon can include several bends, some of which exceed 90 degrees. The length of the colonoscope may be sized to be substantially equal to or longer than the length of a colon of a patient. In some implementations, the length of the colonoscope can be between 3 feet and 8 feet long. Although the present disclosure described herein provides details relating to a colonoscope, one having ordinary skill in the art should appreciate that the endoscope may be a bronchoscope, a laryngoscope, a hysteroscope, any gastroentrology scope or other type of scope insertable within a mammalian cavity of a patient.
• Referring now toFIG. 62, a flow chart depicting a method for resecting material from within a mammalian cavity of a patient is shown. In brief summary, a flexible endoscope is inserted within an opening to a mammalian cavity of a patient, the flexible endoscope inserted within the opening via a distal end of the endoscope (BLOCK6205). A surgical cutting assembly is disposed within an instrument channel of the flexible endoscope (BLOCK6210). A cutting window of an outer cannula of the surgical cutting assembly is positioned at the material within the mammalian cavity to be resected (BLOCK6215). Torque is then provided to rotate the inner cannula relative to the outer cannula (BLOCK6220). A sample retrieval component of the surgical cutting assembly is then actuated to remove the resected material via the aspiration channel (BLOCK6225).
• In further detail, the method includes inserting a flexible endoscope within an opening to a mammalian cavity of a patient, the flexible endoscope inserted within the opening via a distal end of the endoscope (BLOCK6205). The flexible endoscope can be inserted within the opening via a distal end of the endoscope. A medical professional may insert the endoscope. In some implementations, the mammalian cavity can be a colon of the patient, a larynx of the patient, a uterus of the patient, a lung of the patient, a stomach, an esophagus or a duodenum of the patient or any other region in the gastro-intestinal tract, among other mammalian cavities.
• The method includes disposing a surgical cutting assembly within an instrument channel of the flexible endoscope (BLOCK6210). The instrument channel of the endoscope can extend between an opening at the proximal end of the endoscope and another opening at the distal end of the endoscope. The surgical cutting assembly can be inserted into the instrument channel via the instrument channel opening at the proximal end of the endoscope. This end of the endoscope remains outside the opening to the mammalian cavity even after the endoscope has been inserted within the mammalian cavity. As described above, the surgical cutting assembly can be any of the surgical cutting assemblies described above with respect toFIGS. 51A-61B. In some implementations, the surgical cutting assembly can be an endoscopic instrument described above with respect toFIGS. 40A-50B. The surgical cutting assembly can include a cutter assembly having an outer cannula, an inner cannula disposed within an outer cannula, and a cutting window defined along a portion of a radial wall of the outer cannula. The proximal end of the inner cannula can be fluidly coupled to an aspiration channel that extends along a length of the flexible endoscope. The inner cannula can be configured to rotate relative to the outer cannula to cut material entering the cutting window of the outer cannula.
• The method includes positioning, by rotating the outer cannula of the surgical cutting assembly, the cutting window at the material within the mammalian cavity to be resected (BLOCK6215). In some implementations, the outer cannula can be coupled to a distal end of an outer tubing. The outer tubing can be a braided tubing or any other tube or coil configured to rotate the outer cannula by rotating a proximal end of the outer tubing. In some implementations, the outer tubing can be a flexible torque coil.
• The method includes providing torque to rotate the inner cannula relative to the outer cannula via a flexible torque component (BLOCK6220). The torque can be provided by one of a torque generation component disposed within the distal end of the endoscope or via a flexible torque component extending from the proximal end of the endoscope to the distal end of the endoscope. The torque causing the coupling component of the endoscope to rotate and cause the coupling member of the surgical cutting assembly and the inner cannula to rotate relative to the outer cannula to resect at least a portion of the material at the cutting window of the outer cannula. In some implementations, the material can be a lesion, fibrous tissue, or any other growth or appearance formed within the mammalian cavity.
• In some implementations, the method includes actuating the torque generation component. In some implementations, actuating the torque generation component includes providing a fluid to the torque generation component via a fluid entry channel and removing the fluid from the torque generation component via a fluid exit channel. In some implementations, actuating the torque generation component includes providing an electric current to the torque generation component via an electrical wire that extends from the torque generation component to a current source outside the flexible endoscope.
• In some implementations, the method includes actuating a rotary actuator positioned outside the endoscope and connected to the torque delivery component. The torque delivery component is configured to deliver the torque generated by the rotary actuator to the coupling component. The torque delivery component includes a flexible torque coil or flexible torque rope having a plurality of layers of one or more threads, each of the plurality of layers is wound in a direction opposite to a direction in which one or more adjacent layers of the plurality of layers is wound.
• In some implementations, the flexible endoscope includes a coupling component disposed within a distal end of the endoscope. The coupling component can include at least one magnet and the method further includes magnetically coupling the coupling component of the endoscope and the coupling member of the endoscope. In some implementations, the torque generated by the rotary actuator or delivered by the torque delivery component can be provided to the coupling component, which causes the coupling component to rotate. The coupling member can be magnetically coupled to a coupling member of the surgical cutting assembly. The coupling member is coupled to the inner cannula and as such, rotation of the coupling component can cause the inner cannula to rotate.
• The method includes actuating a sample retrieval component of the surgical cutting assembly to remove the resected material via the aspiration channel (BLOCK6225). A suction source may be applied to a proximal end of the aspiration channel that causes material entering the endoscope via the cutting window of the outer cannula and being resected by the inner cannula to be aspirated through the surgical cutting assembly within the aspiration channel. In some implementations, the aspiration channel can be defined by an inner wall of the inner cutter, an inner wall of the coupling member and an inner wall of the aspiration tube. In some implementations in which the inner cannula is rotated via the flexible torque delivery component of the surgical cutting assembly, the aspiration channel can be defined by the inner wall of the inner cutter and the inner wall of the flexible torque delivery component.
• In some implementations, a method of resecting a lesion from within a mammalian cavity of a patient includes inserting a flexible endoscope within an opening to a mammalian cavity of a patient, the flexible endoscope including a coupling component disposed within a distal end of the endoscope, the flexible endoscope inserted within the opening via the distal end. The method includes disposing a surgical cutting assembly within an instrument channel of the flexible endoscope. The surgical cutting assembly inserted into the instrument channel via an instrument channel opening to the instrument channel at a proximal end of the endoscope that remains outside the opening to the mammalian cavity. The surgical cutting assembly including a cutter assembly having an outer cannula, an inner cannula disposed within an outer cannula, and a cutting window defined along a portion of a radial wall of the outer cannula, a proximal end of the inner cannula coupled to a coupling member, the coupling member fluidly coupled to an aspiration tube that extends along a length of the flexible endoscope, the coupling member configured to rotatably couple with the coupling component of the flexible endoscope. The method includes positioning, by rotating the outer cannula of the surgical cutting assembly, the cutting window at the lesion within the mammalian cavity to be resected. The method includes providing torque to the coupling component of the endoscope. The torque provided by one of a torque generation component disposed within the distal end of the endoscope or via a flexible torque component extending from the proximal end of the endoscope to the distal end of the endoscope. The torque causing the coupling component of the endoscope to rotate and cause the coupling member of the surgical cutting assembly and the inner cannula to rotate relative to the outer cannula to resect at least a portion of the lesion at the cutting window of the outer cannula. The method includes actuating a sample retrieval component to provide suction to the aspiration tube to remove the resected portion of the lesion via an aspiration channel defined by an inner wall of the inner cannula, an inner wall of the coupling member and the aspiration tube.
• In some implementations, the method includes actuating the torque generation component. In some implementations, actuating the torque generation component includes providing a fluid to the torque generation component via a fluid entry channel and removing the fluid from the torque generation component via a fluid exit channel. In some implementations, actuating the torque generation component includes providing an electric current to the torque generation component via an electrical wire that extends from the torque generation component to a current source outside the flexible endoscope.
• In some implementations, the method includes actuating a rotary actuator positioned outside the endoscope and connected to the torque delivery component. The torque delivery component is configured to deliver the torque generated by the rotary actuator to the coupling component. The torque delivery component includes a flexible torque coil or flexible torque rope having a plurality of layers of one or more threads, each of the plurality of layers is wound in a direction opposite to a direction in which one or more adjacent layers of the plurality of layers is wound.
• In some implementations, the coupling component includes at least one magnet and the method further includes magnetically coupling the coupling component of the endoscope and the coupling member of the endoscope.
• In some implementations, the method further includes providing irrigation fluid to the surgical cutting assembly via an irrigation fluid delivery channel defined within the endoscope, the irrigation fluid delivery channel including an entry port at a proximal end of the endoscope and a fluid exit port positioned towards the distal end of the endoscope and fluidly coupled to an irrigation entry opening of the surgical cutting assembly, the irrigation entry opening of the surgical cutting assembly fluidly coupled to an irrigation pathway defined between the outer cannula and the inner cannula of the cutter assembly.
• In some implementations, a portion of the irrigation fluid delivery channel is positioned adjacent to at least one of the torque generation component, the coupling component or the torque delivery component to provide a cooling effect to the torque generation component, the coupling component or the torque delivery component.
• In some implementations, positioning, by rotating the outer cannula of the surgical cutting assembly, the cutting window at the lesion within the mammalian cavity to be resected includes actuating an articulation assembly disposed at the distal end of the endoscope, the articular assembly configured to engage with the outer cannula and configured to cause the outer cannula to rotate relative to the endoscope.
• In some implementations, positioning, by rotating the outer cannula of the surgical cutting assembly, the cutting window at the lesion within the mammalian cavity to be resected includes rotating an outer tubing coupled to the outer cannula, the outer tubing configured to cause the outer cannula to rotate relative to the endoscope based on rotating the outer tubing.
• In some implementations, a method of retrieving polyps from a mammalian cavity of a patient includes inserting a flexible endoscope within an opening to a mammalian cavity of a patient. An endoscopic instrument is disposed or inserted within an instrument channel of the flexible endoscope to resect at least a portion of lesion from within the mammalian cavity. The endoscopic instrument including a cutting assembly having an outer cannula, an inner cannula disposed within an outer cannula, and a cutting window defined along a portion of a radial wall of the outer cannula, the inner cannula rotatably coupled to a flexible torque component having a length that extends along a length of the flexible endoscope, the flexible torque component, upon actuation, providing torque to the inner cannula to rotate relative to the outer cannula to resect the portion of the lesion. Irrigation fluid is then provided from a lavage port of the endoscopic instrument that remains outside the flexible endoscope while the endoscopic instrument is disposed within the instrument channel. The lavage port is fluidly coupled to the outer cannula through a rotational coupler coupling the lavage port to an outer tubing connected to the outer cannula. The rotational coupler allowing the outer tubing and the outer cannula to rotate relative to the lavage port upon rotating a portion of the rotational coupler. The outer cannula is then rotated, via rotation of the portion of the rotational coupler, to a position in which the opening of the outer cannula is viewable via a camera of the flexible endoscope. The cutting window of the outer cannula is then positioned at the lesion of the mammalian cavity. The flexible torque component is then actuated to rotate the inner cannula relative to the outer cannula, the inner cannula cutting the portion of the lesion as the inner cannula rotates adjacent to the cutting window. A sample retrieval component of the endoscopic instrument is actuated to remove the cut portions of the lesion from within the mammalian cavity via an aspiration channel defined by an inner wall of the inner cannula and the flexible torque component.
• In some implementations, disposing the endoscopic instrument within the instrument channel of the flexible endoscope includes inserting a distal end of the endoscopic instrument in the instrument channel of the flexible endoscope.
• In some implementations, a proximal connector that is coupled to the flexible torque component and positioned at a proximal end of the endoscopic instrument is engaged with a drive assembly configured to provide torque to the flexible torque component.
• In some implementations, a vacuum source is fluidly coupled to a distal end of the endoscopic instrument to remove, from the endoscopic instrument, portions of the polyp entering the endoscopic instrument via the opening of the outer cannula.
• In some implementations, the flexible torque component includes a flexible torque coil having a plurality of layers of one or more threads, each of the plurality of layers is wound in a direction opposite to a direction in which one or more adjacent layers of the plurality of layers is wound and the aspiration channel is partially defined by an inner wall of the flexible torque coil.
• In some implementations, actuating the flexible torque component and actuating the sample retrieval component of the endoscopic instrument includes actuating the flexible torque component and actuating the sample retrieval component of the endoscopic instrument simultaneously.
• In some implementations, actuating the flexible torque component includes providing torque to the inner cannula that is sufficient to cut at least a portion of the polyp. In some implementations, actuating the flexible torque component includes actuating the flexible torque component to cause an inner cannula of the cutting assembly to rotate relative to the outer cannula via a foot pedal.
• In some implementations, the lesion is a first polyp and the mammalian cavity is a colon. Upon cutting at least a portion of the first polyp and without removing the endoscopic instrument from the flexible endoscope, the opening of the outer cannula is positioned at a second polyp within the colon. The flexible torque component is actuated to rotate the inner cannula relative to the outer cannula, the inner cannula cutting at least a portion of the second polyp. The sample retrieval component of the endoscopic instrument is actuated to remove the cut portion of the second polyp from within the colon.
• In some implementations, a method of removing polyps from within a patient can include inserting a flexible endoscope within an opening of a patient, disposing an endoscopic instrument within an instrument channel of the flexible endoscope to remove a polyp from the surgical site, the endoscopic instrument including a cutting assembly having an outer cannula, an inner cannula disposed within an outer cannula, and an opening defined along a portion of a radial wall of the outer cannula, the inner cannula rotatably coupled to a flexible torque component having a length that extends along a length of the flexible endoscope, the flexible torque component, upon actuation, providing torque to the inner cannula, positioning the opening of the outer cannula at the polyp, actuating the flexible torque component to rotate the inner cannula relative to the outer cannula, the inner cannula cutting a portion of the polyp as the inner cannula rotates adjacent to the opening, and actuating a sample retrieval component of the endoscopic instrument to remove the cut portions of the polyp from within the patient via an aspiration channel defined by an inner wall of the inner cannula and the flexible torque component.
• In some implementations, the method includes providing irrigation fluid from a lavage port of the endoscopic instrument that remains outside the flexible endoscope while the endoscopic instrument is disposed within the instrument channel. The lavage port is fluidly coupled to the outer cannula through a rotational coupler coupling the lavage port to an outer tubing connected to the outer cannula, the rotational coupler allowing the outer tubing and the outer cannula to rotate relative to the lavage port upon rotating a portion of the rotational coupler.
• In some implementations, the method includes rotating, via rotation of the portion of the rotational coupler, the outer cannula to a position in which the opening of the outer cannula is viewable via a camera of the flexible endoscope.
• In some implementations, disposing the endoscopic instrument within the instrument channel of the flexible endoscope includes inserting a distal end of the endoscopic instrument in the instrument channel of the flexible endoscope.
• In some implementations, the method includes engaging a proximal connector that is coupled to the flexible torque component and positioned at a proximal end of the endoscopic instrument with a drive assembly configured to provide torque to the flexible torque component.
• In some implementations, the method includes fluidly coupling a vacuum source to a distal end of the endoscopic instrument to remove, from the endoscopic instrument, cut portions of the polyp entering the endoscopic instrument via the opening of the outer cannula.
• In some implementations, the flexible torque component includes a flexible torque coil having a plurality of layers of one or more threads, each of the plurality of layers is wound in a direction opposite to a direction in which one or more adjacent layers of the plurality of layers is wound and the aspiration channel is partially defined by an inner wall of the flexible torque coil.
• In some implementations, actuating the flexible torque component and actuating a sample retrieval component of the endoscopic instrument includes actuating the flexible torque component and actuating the sample retrieval component of the endoscopic instrument simultaneously.
• In some implementations, actuating the flexible torque component includes providing torque to the inner cannula that is sufficient to cut at least a portion of the polyp. In some implementations, actuating the flexible torque component includes actuating the flexible torque component to cause an inner cannula of the cutting assembly to rotate relative to the outer cannula via a foot pedal.
• In some implementations, the polyp is a first polyp and the method further includes upon cutting at least a portion of the first polyp and without removing the endoscopic instrument from the flexible endoscope, positioning the opening of the outer cannula at a second polyp at another surgical site, actuating the flexible torque component to rotate the inner cannula relative to the outer cannula, the inner cannula cutting at least a portion of the second polyp, and actuating the sample retrieval component of the endoscopic instrument to remove the cut portion of the second polyp from within the patient.
• In some implementations, a method of resecting lesion from within a mammalian cavity of a patient includes inserting a flexible endoscope within an opening to a mammalian cavity of a patient, the flexible endoscope including a coupling component disposed within a distal end of the endoscope, the flexible endoscope inserted within the opening via the distal end. The method includes disposing a surgical cutting assembly within an instrument channel of the flexible endoscope. The surgical cutting assembly inserted into the instrument channel via an instrument channel opening to the instrument channel at a proximal end of the endoscope that remains outside the opening to the mammalian cavity. The surgical cutting assembly including a cutter assembly having an outer cannula, an inner cannula disposed within an outer cannula, and a cutting window defined along a portion of a radial wall of the outer cannula, a proximal end of the inner cannula coupled to a coupling member, the coupling member fluidly coupled to an aspiration tube that extends along a length of the flexible endoscope, the coupling member configured to rotatably couple with the coupling component of the flexible endoscope. The method includes positioning, by rotating the outer cannula of the surgical cutting assembly, the cutting window at the lesion within the mammalian cavity to be resected. The method includes providing torque to the coupling component of the endoscope. The torque provided by one of a torque generation component disposed within the distal end of the endoscope or via a flexible torque component extending from the proximal end of the endoscope to the distal end of the endoscope. The torque causing the coupling component of the endoscope to rotate and cause the coupling member of the surgical cutting assembly and the inner cannula to rotate relative to the outer cannula to resect at least a portion of the lesion at the cutting window of the outer cannula. The method includes actuating a sample retrieval component to provide suction to the aspiration tube to remove the resected portion of the lesion via an aspiration channel defined by an inner wall of the inner cannula, an inner wall of the coupling member and the aspiration tube.
• In some implementations, the method includes actuating the torque generation component. In some implementations, actuating the torque generation component includes providing a fluid to the torque generation component via a fluid entry channel and removing the fluid from the torque generation component via a fluid exit channel. In some implementations, actuating the torque generation component includes providing an electric current to the torque generation component via an electrical wire that extends from the torque generation component to a current source outside the flexible endoscope.
• In some implementations, the method includes actuating a rotary actuator positioned outside the endoscope and connected to the torque delivery component. The torque delivery component is configured to deliver the torque generated by the rotary actuator to the coupling component. The torque delivery component includes a flexible torque coil or flexible torque rope having a plurality of layers of one or more threads, each of the plurality of layers is wound in a direction opposite to a direction in which one or more adjacent layers of the plurality of layers is wound.
• In some implementations, the coupling component includes at least one magnet and the method further includes magnetically coupling the coupling component of the endoscope and the coupling member of the endoscope.
• In some implementations, the method further includes providing irrigation fluid to the surgical cutting assembly via an irrigation fluid delivery channel defined within the endoscope, the irrigation fluid delivery channel including an entry port at a proximal end of the endoscope and a fluid exit port positioned towards the distal end of the endoscope and fluidly coupled to an irrigation entry opening of the surgical cutting assembly, the irrigation entry opening of the surgical cutting assembly fluidly coupled to an irrigation pathway defined between the outer cannula and the inner cannula of the cutter assembly.
• In some implementations, a portion of the irrigation fluid delivery channel is positioned adjacent to at least one of the torque generation component, the coupling component or the torque delivery component to provide a cooling effect to the torque generation component, the coupling component or the torque delivery component.
• In some implementations, positioning, by rotating the outer cannula of the surgical cutting assembly, the cutting window at the lesion within the mammalian cavity to be resected includes actuating an articulation assembly disposed at the distal end of the endoscope, the articular assembly configured to engage with the outer cannula and configured to cause the outer cannula to rotate relative to the endoscope.
• In some implementations, positioning, by rotating the outer cannula of the surgical cutting assembly, the cutting window at the lesion within the mammalian cavity to be resected includes rotating an outer tubing coupled to the outer cannula, the outer tubing configured to cause the outer cannula to rotate relative to the endoscope based on rotating the outer tubing.
• FIG. 63A is a perspective view of a distal portion of a surgical cutting assembly according to embodiments of the present disclosure.FIG. 63B is an exploded view of the distal portion surgical cutting assembly shown inFIG. 63A.FIG. 63C is a perspective cross-sectional view of the distal portion of the surgical cutting assembly shown inFIG. 63A.FIG. 63D is an enlarged view of a portion ofFIG. 63B including a first coupler of the surgical cutting assembly shown inFIG. 63A.FIG. 63E is an enlarged view of a portion ofFIG. 63B including a second coupler of the surgical cutting assembly shown inFIG. 63A.FIG. 63F is a side view of the second coupler of the surgical cutting assembly shown inFIG. 63A.
• Similar to other surgical cutting assemblies described above with respect toFIGS. 53A-61, thesurgical cutting assembly6320 is configured to be insertable within an endoscope and configured to be driven or actuated via the endoscope. In some implementations, thesurgical cutting assembly6320 can be actuated via a rotary actuator or torque generation component of the endoscope or via a torque delivery component configured to deliver torque to the surgical cutting assembly via the endoscope.
• Referring now toFIGS. 63A-63F, the surgical cutting assembly can include anouter cannula6322 that has adistal end6325 and aproximal end6326. A cutting window oropening6328 is defined along a radial wall towards thedistal end6325. The outer surface of the outer cannula can include one or morekey structures6330 configured to engage with opposing structures defined within a portion of the endoscope through which thesurgical cutting assembly6320 is inserted. The outer cannula further includes aninner wall6324 that defines a portion of an irrigation channel orpathway6338.
• Thesurgical cutting assembly6320 also includes aninner cannula6322 configured to be disposed within theouter cannula6322. The inner cannula includes a cutting tip at a distal end of the inner cannula. Theinner cannula6332 is disposed within theouter cannula6322 such that the cutting tip of theinner cannula6332 is adjacent to thecutting window6328 of the outer cannula such that when the inner cannula rotates relative to the outer cannula, material entering the cuttingwindow6328 is resected or cut by the cutting tip of theinner cannula6332.
• Thesurgical cutting assembly6320 also includes acoupling member6350. Thecoupling member6350 includes an outer wall on which at least onekey structure6352 is formed. Thekey structure6352 can be aligned with thekey structure6330 formed on theouter cannula6322. Thecoupling member6350 also includes aninner wall6356. The coupling member can further include one or morefluid pathways6354aand6354bthat are defined in between the outer wall and the inner wall of thecoupling member6350. Thecoupling member6350 is configured to engage with a corresponding component of the endoscope within which thesurgical cutting assembly6320 is inserted. Thecoupling member6350 can be configured to rotate when the corresponding component of the endoscope rotates. Thecoupling member6350 can be coupled to theinner cannula6332 such that when thecoupling member6350 rotates, theinner cannula6332 also rotates relative to theouter cannula6322. In some implementations, thecoupling member6350 can be coupled to the inner cannula via a press fit, weld, coupler or any other means to couple thecoupling member6350 to theinner cannula6332. To prevent the outer cannula from rotating when thecoupling member6350 and theinner cannula6332 rotate, theouter cannula6322 can be configured to engage with an articulation assembly of the endoscope that is configured to rotate the outer cannula relative to theinner cannula6332 and thecoupling member6350. Details of the articulation assembly are provided above with respect toFIGS. 58A and 58B.
• Thesurgical cutting assembly6320 can also include afirst coupler6340 that is configured to couple thecoupling member6350 with theouter cannula6330. Thefirst coupler6340 can include a correspondingkey structure6342 that may be aligned with thekey structures6330 and6352. Thefirst coupler6340 can be configured to allow irrigation fluid flowing through theirrigation channels6354aand6354bto a region defined by theinner wall6324 of theouter cannula6322 and an outer wall of theinner cannula6332, while preventing the irrigation fluid from leaking outside of thesurgical cutting assembly6320. In some implementations, thefirst coupler6340 can also be configured to couple theinner cannula6332 to thecoupling member6350 and also prevent material flowing in an aspiration channel partially defined by theinner wall6334 of theinner cannula6332 and theinner wall6356 of thecoupling member6350 from leaking or escaping. In some implementations, the inner wall of thefirst coupler6340 can include a plurality of ridges configured to frictionally engage with the inner cannula. The grooves between the ridges in thefirst coupler6340 can serve as fluid pathways for allowing irrigation fluid to flow from thecoupling member6350 to the region between theouter cannula6322 and theinner cannula6332.
• Thesurgical cutting assembly6320 can also include anouter tubing6370 that is configured to couple to thecoupling member6350. Theouter tubing6370 can be similar to the outer tubings described above with respect toFIGS. 53A-61. Irrigation fluid that passes through theirrigation pathways6354aand6354bcan be provided via the outer tubing. In some implementations, the inner wall of the outer tubing and an outer wall of anaspiration tubing6380 can define a portion of theirrigation channel6338 that extends from the proximal end of the surgical cutting assembly that remains outside the endoscope to thecutting window6326 of thesurgical cutting assembly6320.
• Theaspiration tubing6380 can be coupled to the inner wall of thecoupling member6350. In some implementations, the aspiration tubing is fluidly coupled to the inner wall of thecoupling member6350 such that material entering the surgical cutting assembly via thecutting window6326 can flow into a portion of an aspiration channel defined by theaspiration tubing6380.
• Thesurgical cutting assembly6320 can include asecond coupler6360 configured to couple theouter tubing6370 and theaspiration tubing6380 to thecoupling member6350. Thesecond coupler6360 is configured to allow thecoupling member6350 to rotate relative to theouter tubing6370 and theaspiration tubing6380. Thesecond coupler6360 can include one ormore openings6364aand6364bthat extend along a length of thesecond coupler6360. Theopenings6364aand6364bcan be sized and configured to allow irrigation fluid flowing between theouter tubing6370 and theaspiration tubing6380 to flow to the region between theouter cannula6322 and theinner cannula6332 via thefluid pathways6354aand6354bof thecoupling member6350.
• Thesecond coupler6360 can include afirst portion6465 configured to engage with thecoupling member6350, asecond portion6466 configured to engage with theouter tubing6470 and athird portion6467 configured to engage with the aspiration tubing6480. The inner wall of thethird portion6467 may define a portion of the aspiration channel.
• FIG. 63G shows a perspective view of thesurgical cutting assembly6320 including the coupling member in a first position.FIG. 63H shows a perspective view of thesurgical cutting assembly6320 including the coupling member at a second position. When the surgical cutting assembly is inserted within the instrument channel of the endoscope, the surgical cutting assembly may be arranged such that thekey structures6330,6342 and6352 are all aligned with one another. In this way, the key structures can engage with a corresponding groove or locking structure that is configured to engage with the key structures. In some implementations, the instrument channel can include a groove or locking structure that extends from a proximal end of the instrument channel towards the distal end of the instrument channel and is configured to engage with thekey structures6330,6342 and6352.
• When the endoscope is actuated to cause the surgical cutting assembly to begin cutting, a coupling component of the endoscope causes thecoupling member6350 of thesurgical cutting assembly6320 to rotate, which in turn, causes theinner cannula6332 to rotate relative to theouter cannula6322. Thefirst coupler6340 and thesecond coupler6360 allow thecoupling member6350 to rotate relative to both theouter cannula6322 and theouter tubing6370. In some implementations, theouter cannula6322 may remain stationary because thekey structure6330 of theouter cannula6322 may engage with an articulation assembly of the endoscope that is positioned such that it is adjacent to the outer cannula when the coupling component of the endoscope is engaged with thecoupling member6350 of thesurgical cutting assembly6320.
• FIG. 64A is a perspective cross-sectional view of an endoscopic assembly including an endoscope and the surgical cutting assembly shown inFIG. 63A according to embodiments of the present disclosure.FIG. 64B is a perspective view of a distal portion of the endoscope shown inFIG. 64A.FIG. 64C is a perspective view of the endoscopic assembly shown inFIG. 64A. Referring now toFIGS. 64A-64C, theendoscopic assembly6400 includes theendoscope6400 similar to other endoscopes described above with respect toFIGS. 51A-61. Theendoscope6400 can include acoupling component6422 configured to couple to thecoupling member6350 of thesurgical cutting assembly6320 disposed within theinstrument channel6410 of theendoscope6400.
• Theendoscope6400 includes atorque generation component6412 that is coupled to thecoupling component6422 via atorque transfer component6420. Thetorque transfer component6420 can transfer the torque generated by thetorque generation component6412 to thecoupling component6422. Thecoupling component6422 can be positioned such that a portion of the instrument channel is disposed within an inner wall of thecoupling component6422. The portion of the instrument channel disposed within the inner wall of thecoupling component6422 can correspond to a portion where thecoupling member6350 of thesurgical cutting assembly6320 will be positioned when theouter cannula6322 of thesurgical cutting assembly6320 is engaged with a corresponding structure formed within theendoscope6400. Thecoupling component6422 and thecoupling member6350 may be brought into contact with another via one or more actuation mechanisms. In some implementations, the inner diameter of thecoupling component6422 of theendoscope6400 can be designed and configured to be reduced in size upon actuation such that the inner wall of the coupling component can engage with thecoupling member6350 of the surgical cutting assembly. In some implementations, the coupling member may include an actuation mechanism through which the coupling member can engage withcoupling component6422. In some implementations, thekey structure6352 of the coupling member can be configured to engage with corresponding engagement components of the coupling component such that when the coupling component rotates, the engagement components come into contact with thekey structures6352 of thecoupling member6350 causing the coupling member to rotate. In some implementations, the engagement components may be ribs, fins, grooves, or other structures formed on an inner wall of the coupling component. The engagement structures may be configured to not engage with the outer cannula when thesurgical cutting assembly6320 is being inserted within theinstrument channel6410 of the endoscope but may engage with the coupling component once thesurgical cutting assembly6320 is inserted and thetorque generation component6412 is actuated.
• As shown in64B, theinner wall6424 of thecoupling component6422 includes agroove structure6426 configured to engage with thekey structure6352 of thecoupling member6350 of thesurgical cutting assembly6320.
• FIG. 64C is a perspective view of a distal tip of the endoscope shown inFIG. 64A. Thedistal tip6402 of theendoscope6400 includes an opening of theinstrument channel6410. As shown, theendoscope6400 can include anarticulation component6434 including at least onegroove structure6436 configured to engage with thekey structure6330 of theouter cannula6322 to articulate the orientation of the cutting window of the outer cannula and also keep the outer cannula stationary as thecoupling member6350 rotates upon actuation of thetorque generation component6412.
• FIG. 65 is a cross-sectional view of a surgical cutting assembly according to embodiments of the present disclosure. Thesurgical cutting assembly6520 includes adistal end6550 that is insertable within the endoscope and aproximal end6560 that remains outside of the endoscope after thesurgical cutting assembly6520 is inserted within the endoscope. Thesurgical cutting assembly6520 includes acutting window6524 defined at a distal tip of thesurgical cutting assembly6520 and anaspiration tube6540 that extends from the proximal end of thesurgical cutting assembly6520 towards thedistal end6550. The remaining portion of thesurgical cutting assembly6520 is substantially similar to theendoscopic instrument4000 shown inFIG. 42 and the reference numerals shown inFIG. 65 correspond to the description provided above with respect toFIG. 42. The proximal end of the surgical cutting assembly6500 can be similar to the surgical cutting assemblies described above with respect toFIGS. 51A-61. In contrast to theendoscopic instrument4000 shown inFIG. 42 which includes theflexible torque coil4080, the surgical cutting assembly6500 includes an aspiration tube. The aspiration tube may be any type of tubing capable of allowing fluid to aspirate from the distal end of the surgical cutting assembly to anaspiration port4092.

Claims (30)

What is claimed is:

1. A method of removing material from within a mammalian cavity of a patient, comprising:

inserting a flexible endoscope within an opening to a mammalian cavity of a patient, the flexible endoscope inserted within the opening via a distal end of the endoscope;

disposing a surgical cutting assembly within an instrument channel of the flexible endoscope, the surgical cutting assembly inserted into the instrument channel via an instrument channel opening to the instrument channel at a proximal end of the endoscope that remains outside the opening to the mammalian cavity, the surgical cutting assembly including a cutter assembly having an outer cannula, an inner cannula disposed within an outer cannula, and a cutting window defined along a portion of a radial wall of the outer cannula, a proximal end of the inner cannula fluidly coupled to an aspiration channel that extends along a length of the flexible endoscope, the inner cannula configured to rotate relative to the outer cannula to cut material entering the cutting window of the outer cannula;

positioning, by rotating the outer cannula of the surgical cutting assembly, the cutting window at the material within the mammalian cavity to be resected;

providing torque to rotate the inner cannula relative to the outer cannula, the torque provided to the inner cannula via a flexible torque component extending from a proximal end of the endoscope to the distal end of the endoscope, the torque sufficient to rotate the inner cannula relative to the outer cannula to resect at least a portion of the material entering the cutting window of the outer cannula; and

actuating a sample retrieval component of the surgical cutting assembly to remove the resected material via the aspiration channel.

2. A method of removing lesions from within a mammalian cavity of a patient, comprising:

inserting a flexible endoscope within an opening to a mammalian cavity of a patient;

disposing an endoscopic instrument within an instrument channel of the flexible endoscope to remove at least one lesion from within the mammalian cavity, the endoscopic instrument including a cutting assembly having an outer cannula, an inner cannula disposed within an outer cannula, and an opening defined along a portion of a radial wall of the outer cannula, the inner cannula rotatably coupled to a flexible torque component having a length that extends along a length of the flexible endoscope, the flexible torque component, upon actuation, providing torque to the inner cannula;

providing irrigation fluid from a lavage port of the endoscopic instrument that remains outside the flexible endoscope while the endoscopic instrument is disposed within the instrument channel, the lavage port fluidly coupled to the outer cannula through a rotational coupler coupling the lavage port to an outer tubing connected to the outer cannula, the rotational coupler allowing the outer tubing and the outer cannula to rotate relative to the lavage port upon rotating a portion of the rotational coupler;

rotating, via rotation of the portion of the rotational coupler, the outer cannula to a position in which the opening of the outer cannula is viewable via a camera of the flexible endoscope;

positioning the opening at the lesion of the mammalian cavity;

actuating the flexible torque component to rotate the inner cannula relative to the outer cannula, the inner cannula cutting a portion of the lesion as the inner cannula rotates adjacent to the opening; and

actuating a sample retrieval component of the endoscopic instrument to remove the cut portions of the lesion from within the mammalian cavity via an aspiration channel defined by an inner wall of the inner cannula and the flexible torque component.

3. The method ofclaim 2, wherein disposing the endoscopic instrument within the instrument channel of the flexible endoscope includes inserting a distal end of the endoscopic instrument in the instrument channel of the flexible endoscope.

4. The method ofclaim 2, further comprising engaging a proximal connector that is coupled to the flexible torque component and positioned at a proximal end of the endoscopic instrument with a drive assembly configured to provide torque to the flexible torque component.

5. The method ofclaim 2, further comprising fluidly coupling a vacuum source to a distal end of the endoscopic instrument to remove, from the endoscopic instrument, portions of the lesion entering the endoscopic instrument via the opening of the outer cannula.

6. The method ofclaim 2, wherein the flexible torque component includes a flexible torque coil having a plurality of layers of one or more threads, each of the plurality of layers is wound in a direction opposite to a direction in which one or more adjacent layers of the plurality of layers is wound and the aspiration channel is partially defined by an inner wall of the flexible torque coil.

7. The method ofclaim 2, wherein actuating the flexible torque component and actuating a sample retrieval component of the endoscopic instrument includes actuating the flexible torque component and actuating the sample retrieval component of the endoscopic instrument simultaneously.

8. The method ofclaim 2, wherein actuating the flexible torque component includes providing torque to the inner cannula that is sufficient to cut at least a portion of the lesion.

9. The method ofclaim 2, wherein actuating the flexible torque component includes actuating the flexible torque component to cause an inner cannula of the cutting assembly to rotate relative to the outer cannula via a foot pedal.

10. The method ofclaim 2, wherein the lesion is a first lesion and further comprising:

upon cutting at least a portion of the first lesion and without removing the endoscopic instrument from the flexible endoscope, positioning the opening of the outer cannula at a second lesion within the mammalian cavity;

actuating the flexible torque component to rotate the inner cannula relative to the outer cannula, the inner cannula cutting at least a portion of the second lesion; and

actuating the sample retrieval component of the endoscopic instrument to remove the cut portion of the second lesion from within the mammalian cavity.

11. A method of removing lesions from within a patient, comprising:

inserting a flexible endoscope within an opening of a patient;

disposing an endoscopic instrument within an instrument channel of the flexible endoscope to remove a lesion from the surgical site, the endoscopic instrument including a cutting assembly having an outer cannula, an inner cannula disposed within an outer cannula, and an opening defined along a portion of a radial wall of the outer cannula, the inner cannula rotatably coupled to a flexible torque component having a length that extends along a length of the flexible endoscope, the flexible torque component, upon actuation, providing torque to the inner cannula;

positioning the opening of the outer cannula at the lesion;

actuating the flexible torque component to rotate the inner cannula relative to the outer cannula, the inner cannula cutting a portion of the lesion as the inner cannula rotates adjacent to the opening; and

actuating a sample retrieval component of the endoscopic instrument to remove the cut portions of the lesion from within the patient via an aspiration channel defined by an inner wall of the inner cannula and the flexible torque component.

12. The method ofclaim 11, further comprising providing irrigation fluid from a lavage port of the endoscopic instrument that remains outside the flexible endoscope while the endoscopic instrument is disposed within the instrument channel, the lavage port fluidly coupled to the outer cannula through a rotational coupler coupling the lavage port to an outer tubing connected to the outer cannula, the rotational coupler allowing the outer tubing and the outer cannula to rotate relative to the lavage port upon rotating a portion of the rotational coupler.

13. The method ofclaim 12, further comprising rotating, via rotation of the portion of the rotational coupler, the outer cannula to a position in which the opening of the outer cannula is viewable via a camera of the flexible endoscope.

14. The method ofclaim 11, wherein disposing the endoscopic instrument within the instrument channel of the flexible endoscope includes inserting a distal end of the endoscopic instrument in the instrument channel of the flexible endoscope.

15. The method ofclaim 11, further comprising engaging a proximal connector that is coupled to the flexible torque component and positioned at a proximal end of the endoscopic instrument with a drive assembly configured to provide torque to the flexible torque component.

16. The method ofclaim 11, further comprising fluidly coupling a vacuum source to a distal end of the endoscopic instrument to remove, from the endoscopic instrument, cut portions of the lesion entering the endoscopic instrument via the opening of the outer cannula.

17. The method ofclaim 11, wherein the flexible torque component includes a flexible torque coil having a plurality of layers of one or more threads, each of the plurality of layers is wound in a direction opposite to a direction in which one or more adjacent layers of the plurality of layers is wound and the aspiration channel is partially defined by an inner wall of the flexible torque coil.

18. The method ofclaim 11, wherein actuating the flexible torque component and actuating a sample retrieval component of the endoscopic instrument includes actuating the flexible torque component and actuating the sample retrieval component of the endoscopic instrument simultaneously.

19. The method ofclaim 11, wherein actuating the flexible torque component includes providing torque to the inner cannula that is sufficient to cut at least a portion of the lesion.

20. The method ofclaim 11, wherein the lesion is a first lesion and further comprising:

upon cutting at least a portion of the first lesion and without removing the endoscopic instrument from the flexible endoscope, positioning the opening of the outer cannula at a second lesion at another surgical site;

actuating the flexible torque component to rotate the inner cannula relative to the outer cannula, the inner cannula cutting at least a portion of the second lesion; and

actuating the sample retrieval component of the endoscopic instrument to remove the cut portion of the second lesion from within the patient.

21. A method of resecting lesions from within a mammalian cavity of a patient, comprising:

inserting a flexible endoscope within an opening to a mammalian cavity of a patient, the flexible endoscope including a coupling component disposed within a distal end of the endoscope, the flexible endoscope inserted within the opening via the distal end;

disposing a surgical cutting assembly within an instrument channel of the flexible endoscope, the surgical cutting assembly inserted into the instrument channel via an instrument channel opening to the instrument channel at a proximal end of the endoscope that remains outside the opening to the mammalian cavity, the surgical cutting assembly including a cutter assembly having an outer cannula, an inner cannula disposed within an outer cannula, and a cutting window defined along a portion of a radial wall of the outer cannula, a proximal end of the inner cannula coupled to a coupling member, the coupling member fluidly coupled to an aspiration tube that extends along a length of the flexible endoscope, the coupling member configured to rotatably couple with the coupling component of the flexible endoscope;

positioning, by rotating the outer cannula of the surgical cutting assembly, the cutting window at the lesion within the mammalian cavity to be resected;

providing torque to the coupling component of the endoscope, the torque provided by one of a torque generation component disposed within the distal end of the endoscope or via a flexible torque component extending from the proximal end of the endoscope to the distal end of the endoscope, the torque causing the coupling component of the endoscope to rotate and cause the coupling member of the surgical cutting assembly and the inner cannula to rotate relative to the outer cannula to resect at least a portion of the lesion at the cutting window of the outer cannula; and

actuating a sample retrieval component to provide suction to the aspiration tube to remove the resected portion of the lesion via an aspiration channel defined by an inner wall of the inner cannula, an inner wall of the coupling member and the aspiration tube.

22. The method ofclaim 21, further comprising actuating the torque generation component.

23. The method ofclaim 22, wherein actuating the torque generation component includes providing a fluid to the torque generation component via a fluid entry channel and removing the fluid from the torque generation component via a fluid exit channel.

24. The method ofclaim 22, wherein actuating the torque generation component includes providing an electric current to the torque generation component via an electrical wire that extends from the torque generation component to a current source outside the flexible endoscope.

25. The method ofclaim 21, further comprising actuating a rotary actuator positioned outside the endoscope and connected to the torque delivery component, the torque delivery component configured to deliver the torque generated by the rotary actuator to the coupling component, the torque delivery component including a flexible torque coil or flexible torque rope having a plurality of layers of one or more threads, each of the plurality of layers is wound in a direction opposite to a direction in which one or more adjacent layers of the plurality of layers is wound.

26. The method ofclaim 21, wherein the coupling component includes at least one magnet and further comprising:

magnetically coupling the coupling component of the endoscope and the coupling member of the endoscope.

27. The method ofclaim 21, further comprising providing irrigation fluid to the surgical cutting assembly via an irrigation fluid delivery channel defined within the endoscope, the irrigation fluid delivery channel including an entry port at a proximal end of the endoscope and a fluid exit port positioned towards the distal end of the endoscope and fluidly coupled to an irrigation entry opening of the surgical cutting assembly, the irrigation entry opening of the surgical cutting assembly fluidly coupled to an irrigation pathway defined between the outer cannula and the inner cannula of the cutter assembly.

28. The method ofclaim 27, wherein a portion of the irrigation fluid delivery channel is positioned adjacent to at least one of the torque generation component, the coupling component or the torque delivery component to provide a cooling effect to the torque generation component, the coupling component or the torque delivery component.

29. The method ofclaim 27, wherein positioning, by rotating the outer cannula of the surgical cutting assembly, the cutting window at the lesion within the mammalian cavity to be resected includes actuating an articulation assembly disposed at the distal end of the endoscope, the articular assembly configured to engage with the outer cannula and configured to cause the outer cannula to rotate relative to the endoscope.

30. The method ofclaim 21, wherein positioning, by rotating the outer cannula of the surgical cutting assembly, the cutting window at the lesion within the mammalian cavity to be resected includes rotating an outer tubing coupled to the outer cannula, the outer tubing configured to cause the outer cannula to rotate relative to the endoscope based on rotating the outer tubing.

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